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• Go Back to Open Positions

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• Apply for the Clinical Reviewer Position

Key Responsibilities:

The Clinical Reviewer performs medical case review functions as required under Healthcare Quality Strategies, Inc.'s (HQSI's) various review and appeals programs. Additional responsibilities include ensuring assigned deliverables are completed in an efficient and effective manner in accordance with established time frames that meet or exceed HQSI and client expectations. The Clinical Reviewer will provide excellent customer service to consumers, providers, physicians, and co-workers.

Knowledge of:

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• Utilization and quality of care review concepts

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• Current medical standards of practice

Experience in:

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• Performing utilization and quality of care review

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• Interpreting and applying screening criteria (Interqual and/or Milliman)

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• Writing and generating error-free, complex, user-friendly correspondence under tight time frames

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• Anticipating customer needs and giving high priority to customer satisfaction

Skills requirements include:

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• Ability to multi task and meet strict deadlines

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• Excellent interpersonal communications skills with strong emphasis on customer satisfaction

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• Effective writing skills

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• Strong computer skills (Word, Excel, Internet Explorer)

Educational background:

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• RN with five to seven years of clinical experience and recent utilization or case management experience

Reports to Director, Review

Date Posted:  January 28, 2010