Clinical Reviewer - LCSW/LCPC - (Remote)
Posted on: June 25, 2022
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
Full Time Clinical Reviewer - Remote LCPC or LCSW
This is a remote position, where you can work from home. However
you must live in the state Maine and have an active LCPC and/or
LCSW is required.
Summary DescriptionUtilizes clinical expertise for the review of
medical records against appropriate criteria in conjunction with
contract requirements, critical thinking and decision-making skills
to determine medical appropriateness, while maintaining production
goals and QA standards. Ensures day-to-day processes are conducted
in accordance with NCQA, URAC and other regulatory standards.
- 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
- 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.
- Performs ongoing reassessment of review process to offer
opportunities 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
- Responsible for attending training and scheduled meetings and
for maintenance and use of current/updated information for
- 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
- Actively 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.
- Active LCPC and/or LCSW is required.
- Graduation from an accredited Master's Degree Program.
Knowledge, Skills, Abilities
- Knowledge of current NCQA/URAC standards strongly
- Medical record abstracting skills required.
- Knowledge of the organization of medical records, medical
terminology, and disease process required.
- Strong clinical assessment and critical thinking skills
- Excellent verbal and written communication skills
- Ability to work in a team environment.
- Flexibility and strong organizational skills needed.
- Must be proficient in Microsoft Office and internet/web
- Minimum of one year UR and/or Prior Authorization or related
- For BH Programs: Minimum 3 years direct behavioral/mental
health experience in a clinical setting or other applicable State
and/or Compact State clinical experience or license per contract
Mental and Physical RequirementsThe 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
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/DisabilityKepro 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
Keywords: Kepro, Baltimore , Clinical Reviewer - LCSW/LCPC - (Remote), Healthcare , Baltimore, Maryland
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