Title: Clinical Reviewer Location: Remote Position: Contract Note: Need a CA LIC as a Social Worker or LMFT.Certification required (one of these) - LCSW, LPCC, LMFT – Either of these certifications are fine, but one of them needs to be active in the state of CA. Need this person ONLY for weekends (6-8 hours on Saturday and Sunday). There will be training before they can be on their own, that training will be provided on flexible times on WEEKDAYS (they can do early morning, late evening etc). Responsibilities: Assures accuracy and timeliness of all applicable review type cases within contract requirements. Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department Review medical records against appropriate criteria in conjunction with contract requirements. In collaboration with Supervisor, responsible for quality monitoring activities. Maintains current knowledge base related to review processes and clinical practices. Functions as providers' liaison for customer service issues and problem resolution. Performs all applicable review types as workload indicates. Fosters positive and professional relationships with internal and external customers. Attends training and scheduled meetings for current/updated information. Cross trains to provide flexible workforce to meet client/customer needs. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Knowledge of medical records, medical terminology, and disease processes required. Strong clinical assessment and critical thinking skills required. Excellent written and verbal communication skills required. Will be doing quality management, will be reading in-patient facility charts. They use Atrezzo system but any EMR software experience is fine.
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