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Supervisor, Clinical Review in Scarborough, ME at KEPRO

Date Posted: 1/29/2018

Job Snapshot

Job Description

KEPRO

 

JOB TITLE:            Supervisor,Clinical Review

REPORTS TO:      Director,Clinical

FLSA STATUS:     Exempt

Summary Description

Supervises Review Operations day-to-day activities of thereviewers in the assigned areas to successfully meet contract deliverables.  Assists in meeting contract deliverablesrelated to the Review Department within budgetary parameters.

Accountabilities

 

  • Assures accuracy and timeliness of allapplicable review type cases within contract requirements. 
  • Assesses, evaluates and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands ofthe department.
  • Analyzes productivity of reviewers.
  • Identify Clinical Reviewers’ orientation andcontinuous learning needs and in collaboration with the Manager, Operations,develops and implements plans to address those identified learning needs.
  • Responsible for the quality monitoringactivities including identifying areas of improvement and plan implementationof improvement areas.
  • Maintains current knowledge base related toreview processes and clinical practices related to the review processes;functions as the initial resource to reviewers regarding all review processquestions and/or concerns.
  • Functions as providers’ liaison andcontact/resource person for provider customer service issues and problemresolution.
  • Performs all applicable review types as workloadindicates.

The list of accountabilities is not intended to beall-inclusive and may be expanded to include other duties that management may deemnecessary from time to time.

Qualifications

 

  • LCSW or LCPC
  • Excellent verbal and written communicationskills essential.
  • Excellent interpersonal skills required.
  • Organizational skills, ability to plan andprioritize multiple assignments essential.
  • Computer proficiency in Microsoft Office andother software programs operating in a Windows environment.

Experience

  • Minimum of three (3) years supervisoryexperience in a health-care field with a minimum of 1-3 years review experiencerequired.
  • Two years recent clinical experience.
  • Previous workload management experience stronglypreferred.

Mental and PhysicalRequirements

The physical demands described here are representative ofthose that must be met by an employee to successfully perform the essentialfunctions of this job.  Reasonableaccommodations will be made as required by law in an attempt to enable anindividual with a disability to perform the essential functions of thisjob.  While performing the duties of thisjob, the employee must have the ability to read and interpret data and complexinformation and function in a team environment. In addition, the employee is required to sit for extended periods oftime; key and/or control objects; occasionally lift and/or move objectsweighing up to 10 pounds; use a personal computer; safely operate anautomobile, travel throughout the state, and communicate effectively withinternal and external customers.

Equal Opportunity Employer

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