Clinical Reviewer ? (Remote ? California ? LCSW/LMFT/LPCC) ? PRN/Weekends in Riverside, CA in Kepro

Job title: Clinical Reviewer - (Remote - California - LCSW/LMFT/LPCC) - PRN/Weekends

Company: Kepro

Job description: Job Description:

Clinical Reviewer- Weekends (Remote)
? This is an hourly PRN position requiring weekend and holiday coverage.
? Are you an experienced Therapist or Social Worker looking for a new challenge?
? Do you value care management and quality improvement?
? Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

Who we need:

The Clinical Reviewer is a licensed Marriage and Family Therapist or Licensed Clinical Social Worker who utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction of contract requirements, critical thinking and decision-making skills to determine medical appropriateness of psychiatric inpatient level of care, while maintaining production goals and QA standards. Supports overall consistency, thoroughness, and accuracy of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA). Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards.

Why us?

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.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

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 correspondence.
? 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 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
? 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.

Shift:
? Four Weekend days a month minimum.
? Three Holidays a year minimum.
? Must be located in California.

What you'll need:

Required Qualifications
? Active California License Required (ie. LPCC, LCPC, LMFT, LCSW).
? Please note that nursing credentials do not meet the qualifications for this position.
? Graduation from an accredited Master's Degree Program.

Knowledge, Skills, Abilities
? Knowledge of Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part 438.910)
? Knowledge of Medicaid programs with relevant experience navigating similar complex projects.
? Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use in California.
? Knowledge of standards of practice related to determination of Level of Care.
? Knowledge of standards of practice related to mental health and other disorders typically requiring psychiatric inpatient.
? Knowledge and understanding of public sector services and supports.
? Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.
? Ability to determine a clinical diagnosis accounting for psychological and behavioral issues.
? Ability to utilize computer equipment and web based software to conduct work.
? Ability to interact with various office staff as needed to support necessary workflows.
? Ability to interact with healthcare professionals, patients, their families and other supports.
? Ability to communicate effectively to individuals and groups through spoken, written and electronic media.
? Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.
? Assesses and analyzes psychological, emotional, behavioral and physical functioning.
? Develops level of care recommendations based upon clinical evaluations.

Experience
? Minimum experience of five (5) years managing and/or working with Medicaid, government health plans, or hospital programs is required.

Thank You!

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.

Expected salary:

Location: Riverside, CA

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