The Clinical Reviewer performs medical record reviews to determine quality of care, identifies quality issues and assures compliance with medical record standards and regulatory mandates. This position works collaboratively with Fidelis providers, and educates them on all aspects of medical record review criteria including QARR. Additional responsibilities includ coordinating onsite reviews and communicating regularly with members and regulatory agencies.
- Assess treatment needs and make recommendations that impact desired outcomes and quality of care.
- Must have superior verbal and written communication skills to communicate with providers, members and staff.
- Position required 20% overall field travel.
- Must have own transportation and valid driver's licence.
- RN, LPN and FMGs preferred.
- 1 to 2 years RN experience required.
- Previous Review Experience strongly preferred.