Job Information
QUALIS HEALTH Clinical Reviewer in MILWAUKEE, Wisconsin
JOB REQUIREMENTS: Clinical Reviewer Part-Time LinkedIn Twitter Email Message Share Category Care Management Job Location Remote Tracking Code 134739 Industry Select Industry Job Level Mid Career Position Type Part-Time Years of Experience Not Applicable Who is Comagine Health? Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level. Purpose Comagine Health is looking for a part-time (20 hours per week) Clinical Reviewer. While this position is part-time it is benefits eligible. Assess the medical necessity and quality of healthcare services by conducting prospective, concurrent, and retrospective utilization management reviews. Education BA/BS in a nursing field Years of Experience in Related Field Required 3 years of clinical (direct patient care) experience Preferred + 1 year of utilization Review experience Experience with developmentally disabled patients Licensure Required Current, active, unrestricted clinical licensure as required by the state of New Mexico. Specialized Knowledge, Skills, and Abilities and/or Competencies Strong MS Office Suite proficiency and familiarity with database software programs Strong organizational skills Excellent oral and written communications skills Excellent interpersonal and problem-solving skills Ability to organize and coordinate multiple simultaneous tasks in a team environment InterQual Criteria experience Typical Job Duties and Responsibilities Apply clinical review criteria, organizational policies, guidelines, and screens to determine the medical necessity of health care services. Consult with physician/practitioner consultants when reviews fail clinical review criteria, guidelines, and screens. Refer cases to others when collaboration as required. Refer cases to management as needed. Provide clinical and/or review process subject matter expertise, respond to customers questions or concerns. If needed, conduct an outreach to consultants, community support coordinators, case managers, and/or providers for required additional information May... For full info follow application link. Equal Employment Opportunity Employment Comagine Health is an Equal Employment Opportunity/Affirmative Action Employer that embraces and practices diversity, reflecting the communities we serve. We encourage minorities, protected veterans and individuals with disabilities to apply. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/B2AF4C9B55CA4045