Clinical Reviewer - Remote Position
Posted on: May 14, 2022
Clinical Reviewer - Remote Position
- Are you an experienced Clinical Reviewer looking for a new
- Do you value care management and quality improvement?
- Are you motivated, energetic, and excited to become part of the
If so, you might be our next new team member!
- This is a fully remote position**
Who We Need
Clinical Reviewers utilize their expertise to determine medical
necessity by reviewing medical records and comparing against
appropriate criteria, benefit plan, and contract requirements.
Reviewers use critical thinking and decision-making skills to
determine medical appropriateness of psychiatric or substance abuse
inpatient level of care, as well as various outpatient therapies
and services. In this role you will support overall consistency,
thoroughness, and accuracy of the review process, while maintaining
production goals and Quality Assurance (QA) standards. You will
also ensure that day-to-day processes are conducted in accordance
with URAC and other regulatory standards.
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
People Focused. Mission Driven.
Shape the future of healthcare with us. We are mission driven to
improve lives through healthcare quality and clinical
We do this through our people.
At Kepro, you can do meaningful work that makes a real difference
for the lives of individuals across the country. We are an
organization that cares deeply about our employees and we provide
the training and support to do the best work of your career.
Benefits are a key component of your rewards package at Kepro.
These benefits are designed to provide you and your family
additional protection, security, and support for both your career
and your life away from work. They are comprehensive and fit a
variety of needs and situations. Our benefits include comprehensive
health plans, paid time off, retirement savings, corporate
wellness, educational assistance, corporate discounts and more.
What You'll Do
- Reviews and interprets patient records and compares against
criteria to determine medical necessity and appropriateness of
care; determines if the medical record documentation supports the
need for services.
- Determines approval or initiates a referral to the physician
consultant and processes physician consultant decisions ensuring
reason for the denial is described in sufficient detail on
- Performs ongoing reassessment of review process to offer
opportunities for improvement and/or change.
- Fosters positive and professional relationships and acts as
liaison with internal and external customers to ensure effective
working relationships and team building to facilitate the review
- Always maintains medical records confidentiality 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
- Actively cross-trains to perform duties of other contracts
within KEPRO to provide a flexible workforce to meet
- Other duties as assigned
- Abstracts review related data/information accurately and timely
on appropriate review tool by the appropriate means. Accurate and
timely submission of all administrative and review related
documents to appropriate parties.
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.
What You'll Need
- BCBA, LCSW, LCPC, LPCC, LMFT with active license is
Knowledge, Skills, Abilities
- Knowledge of utilization management program and processes with
- Knowledge of psychiatric and substance use disorders
- Knowledge of standards of practice related to mental health and
other disorders typically requiring psychiatric inpatient.
- Develops level of care recommendations based upon clinical
- Assesses and analyzes psychological, emotional, behavioral and
- Ability to attend to detail, effectively prioritize and execute
tasks in a timely manner.
- Ability to communicate effectively to individuals and groups
through spoken, written and electronic media.
- Ability to interact with healthcare professionals, patients,
their families and other supports.
- Ability to interact with various office staff as needed to
support necessary workflows.
- Ability to utilize computer equipment and web-based software to
- Ability to determine a clinical diagnosis accounting for
psychological, substance use and behavioral issues.
- Computer proficiency in Microsoft Excel, Word, PowerPoint,
Teams, and Outlook.
- Knowledge of Parity in Mental Health and Substance Use Disorder
Services Final Rule (Parity Rule; Title 42 of the CFR, part
- Knowledge of standards of practice related to determination of
Level of Care.
- Knowledge of InterQual criteria
- Minimum 3 years direct behavioral/mental health experience in a
clinical setting required
- Minimum of 1 year utilization review experience in a health
plan environment required
- Working knowledge of InterQual criteria application strongly
- Experience with commercial health plans preferred.
We know your time is valuable and we thank you in advance for
applying for this position. Due to the high volume of applicants we
receive, only those who are chosen to advance in our interview
process will be contacted. We sincerely appreciate your interest in
Kepro and invite you to apply to future openings that may be of
interest. Best of luck in your search!
- The Kepro Talent Acquisition Team
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.
EOE AA M/F/Vet/Disability
Kepro is an 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.
Keywords: Kepro, Seattle , Clinical Reviewer - Remote Position, Healthcare , Seattle, Washington
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