Clinical Reviewer - Remote - (LCSW/LMHC/RN)

Clinical Reviewer (Remote - LCSW/LMHC/RN/PsyD/PhD)

• Are you an experienced Clinical Reviewer looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

Who we need:

The Clinical Reviewer completes comprehensive PASRR determinations for individuals with serious mental illness, intellectual disability, or related conditions, who require nursing facility level of services. Summary determinations are person-centered assessments utilizing medical and behavioral health records, evaluations, and treatment team consultations and will include the need for confirming diagnoses and making recommendations for care, including specialized services, within integrated settings.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you’ll do:

• Utilizes PASRR Level I screenings and PASRR Level II evaluations to make comprehensive and person-centered determinations.
• Provide timely and accurate clinical assessment of the patient through review of relevant records, staff evaluations, and interviews with collateral sources and our Medical Director.
• Provide thorough review to confirm if individuals meet established criteria for Serious Mental Illness (SMI), and/or Intellectual Disability or Other Related Conditions (ID/RC) based on federal, state, and contractual standards.
• Ensures accurate PASRR review completion by determining appropriate level of care based on the patient’s physical, behavioral, and psychological functioning and medical, behavioral health, and social histories.
• Ensures compliance with necessary workflow turnaround times which can include re-review of records based upon input from the Clinical Director, Quality Manager, and/or Medical Director.
• Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned.
• Review current literature, regulations and research related to long term care, mental illness, intellectual disabilities, medical conditions and geriatrics.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

What you’ll need:

Required Qualifications

• Registered Nurse, licensed in the state of Florida, Licensed Clinical Social Worker, Licensed Clinical Psychologist, Nurse Practitioner, or other qualified Mental Health Professional/Qualified Intellectual Disability Professional.
• Graduation from an accredited College with relevant Degree Program.

Knowledge, Skills, Abilities

• Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use in Florida.
• Knowledge of standards of practice related to determination of Level of Care.
• Knowledge of standards of practice related to mental health, intellectual and developmental disabilities, geriatrics, and other disorders typically requiring long term care services and supports.
• Knowledge and understanding of public sector services and supports.
• Working knowledge of Federal Regulation 42 CFR, Chapter 483.
• Computer proficiency in Microsoft Excel, Word and Outlook.
• Ability to determine a clinical diagnosis accounting for psychological and behavioral issues.
• Ability to utilize computer equipment and web-based software to conduct work.
• Ability to interact with various office staff as needed to support necessary workflows.
• Ability to interact with healthcare professionals, patients, their families, and other supports.
• Ability to communicate effectively to individuals and groups through spoken, written, and electronic media.
• Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.
• Assesses and analyzes psychological, emotional, behavioral and physical functioning.
• Develops level of care recommendations based upon clinical evaluations.

Experience

• Minimum of 3 years’ experience in the assessment and/or diagnosis of individuals with mental/psychiatric disorders, including complex differential diagnoses that are related to substance use, medical conditions, cognitive issues, and dementia.
• Experience with geriatric population is preferred.
• Minimum of (1) year of experience in working with individuals with intellectual disability or related conditions.

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Kepro Talent Acquisition Team

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.