Healthcare - Nurse Reviewer / Field Nurse Reviewer

  Nurse Reviewer / Field Nurse Reviewer

Looking for a rewarding and challenging career?  KePRO, a national company offering health care management solutions backed by over 20 years of progressive experience and growth, is currently seeking  highly skilled Nurse Reviewers with a variety of clinical experiences to join our team of Nurse Reviewers in our Hunt Valley, Maryland office location. 

Nurse Reviewer is primarily responsible for performing utilization and quality reviews; however, will perform various other types of review during fluctuating workloads.

Field Nurse is primarily responsible for performing utilization and quality reviews on-site in Long Term Care facilities however, will perform various other types of review during fluctuating workloads. 

Job Duties:

• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the plan of care is followed in a timely manner and that the medical record documentation supports the delivery of quality care. 
• Makes the decision to approve a record or initiate 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.
• Ongoing reassessment of review process to offer opportunity 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’s policies, procedures and guideline
• Willingness to cross train and perform duties of other contracts within KePRO to provide a flexible workforce to meet client/consumer needs.

In addition to a competitive salary, KePRO offers a comprehensive benefits package, which includes Health & Disability Insurance, Tuition Assistance, Flexible Schedule, PTO, and 401 k.

Candidate must have the ability to work in a team environment. Good verbal & written communication skills. Strong critical thinking skills. Flexibility. Good organizational skills. Medical record abstracting skills.

Education/Experience: Current MD RN license 2 yrs. clinical experience,both acute and long term care experience preferred 1 yr. utilization review experience. InterQual criteria preferred. Computer skills highly desirable.

To apply:

Please send resume and cover letter with salary requirements to [Click Here to Email Your Resumé].

Or fax to 813-262-9464.

Only those candidates identified for an interview will be contacted.

No Phone Calls Please.

Visit our main site at www.kepro.org for more information on our family of companies.

Help us advance the quality and efficiency of healthcare to meet the needs of our customers. Join Our KePRO Team Today!

KePRO is an equal opportunity employer.