11 days old

Clinical Assessor (Remote)

Keystone Peer Review Organization, Inc.
Franklin, NH 03235 Work Remotely
  • Job Code
    CLINI02529-00001



KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.KEPRO is seeking resumes for a highly experienced professional



**Seeking qualified candidates in Claremont, Concord, Franklin, Hillsborough,Lebanon, Newbury, New London and surrounding areas**



Clinical Assessor



Summary Description



Within the scope of service, nurse assessors will meet face to face with clients in order to conduct medical eligibility assessments and/or PASRR screenings.



Accountabilities



  • Conducts member and/or provider assessments, audits, training and consultation to assure plans and interventions are appropriate. As appropriate, monitors and evaluates the services and community based resources necessary to respond to the individual members health needs.

  • Uses independent judgment, clinical knowledge/competence, communication skills, problem solving and conflict resolution to ensure optimal member, provider and client outcomes with consideration to payor requirements.

  • Ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards.

  • Seeks consultation from physicians, clinical and other disciplines and departments as required to ensure appropriate care is being rendered.

  • Ongoing reassessment of processes to offer opportunity for improvement and/or change.

  • Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.

  • Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.

  • Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.

  • Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following KEPRO policies, procedures and guidelines

  • Cross-trains to perform duties of other contracts within the KEPRO network to provide a flexible workforce to meet client/consumer needs.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time



Qualifications



  • Active unrestricted Registered Nurse (RN)License

  • Associates Degree or Bachelors Degree Program

Knowledge, Skills, Abilities



  • Knowledge of NCQA/URAC standards strongly preferred.

  • Knowledge of the organization of medical records, medical terminology, and disease process required.

  • Strong clinical/social assessment and critical thinking skills required.

  • Excellent verbal and written communication skills required.

  • Ability to use independent judgment and discretion to address, resolve and process problems impeding the service needs.

  • Proactively identify and resolves delays and obstacles.

  • Ability to work in a team environment.

  • Flexibility and strong organizational skills needed.

  • Must be proficient in MS Office, Internet/Web Navigation

  • Must have high-speed (no dial-up) internet at home.

  • Must be willing to travel and have active, unrestricted license, reliable transportation and active auto insurance.

  • Must have an OSHA complaint home workspace committed to confidentiality of PHI.

Experience



  • Minimum of one year UR and/or Prior Authorization,Assessing,QA, Case Management or related experience.

  • Basic computer skills (copy/cut, paste, maneuvering screens and typing) necessary.

Mental and Physical Requirements



  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements.Only those candidates identified for an interview will be contacted.No Phone Calls Please.Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.



EOE AA M/F/Vet/Disability



KEPRO is and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.



Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities



The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR 60-1.35(c)



See job description





Posted: 2020-06-29 Expires: 2020-07-28
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Clinical Assessor (Remote)

Keystone Peer Review Organization, Inc.
Franklin, NH 03235

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