Clinical Review Specialist

Virginia Information Technologies Agency • Staunton, VA

1d • $77,234 - $106,583 • Onsite

About The Position

This position is responsible for evaluating the delivery of care through the Utilization Review (UR) Process, including data collection, analysis, and reporting. The role involves communication with Medicaid and private insurance third-party payers and regulatory agencies, as well as employee health responsibilities.

Requirements

• Psychiatric/clinical nursing expertise
• Demonstrated knowledge of inpatient psychiatric treatment and documentation requirements to meet State and Federal Medicaid regulations
• HIPPA and Compliance regulations
• Skilled in analyzing complex clinical documentation to identify discrepancies and recommends improvements, facilitating ongoing quality enhancement efforts
• Ability to communicate effectively, orally and in writing with clinicians, administrators, and patients, patients’ families, and external agencies
• Basic computer proficiency with typing, and knowledge of MS Word, and MS Excel
• Must possess ASN and active RN license

Nice To Haves

• BSN Preferred
• Clinical delivery experience in an inpatient psychiatric setting required
• Prior experience in data management and analysis, utilization review, Medicaid and third party commercial insurances preferred
• Experience with medical reviewers preferred
• Experience with Joint Commission standards preferred

Responsibilities

• Evaluate delivery of care through Utilization Review (UR) Process
• Data collection analysis and reporting
• Communicate with Medicaid and private insurance third party payers and regulatory agencies
• Employee Health responsibilities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree