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Clinical Reviewer Nurse
Integrated Home Care Services, Inc.. Ensure home health care services are administered with quality, cost efficiency, and within compliance .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management, ensuring compliance and quality in home health care services while effectively coordinating patient care with a multi-disciplinary team. Proficient in maintaining accurate records and conducting thorough reviews of patient treatment files.
Highest-signal resume keywords
State Licensure As A LPN Or RNUtilization Management ExperienceUtilization Management Or Case Management CertificationKnowledge Of Word Processing And Spreadsheet ProgramsPatient Care Coordination
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
Effective InteractionOrganizational Skills
Certifications & Qualifications
Utilization Management CertificationCase Management Certification
Industry Keywords
Home Health Care ServicesPatient Treatment FilesConcurrent ReviewPrecertification RequestsMedical NecessityMulti-Disciplinary Healthcare TeamPatient-Related InteractionsCost EfficiencyQuality AssuranceCompliance
About the role
Key responsibilities & impact- Ensure home health care services are administered with quality, cost efficiency, and within compliance
- Continuously review and audit patient treatment files
- Conduct concurrent review of patient clinical information for efficiency
- Review precertification requests for medical necessity
- Coordinate patient care needs with a multi-disciplinary healthcare team
- Maintain accurate records of all patient-related interactions
- Provide updates to the Manager of Utilization Management for review
- Interact effectively with others and stay organized
Requirements
What you’ll need- State licensure as a LPN or RN
- Minimum 2 years of prior experience in Utilization Management
- Strong knowledge of word processing and spreadsheet computer programs
- Utilization Management or Case Management certification preferred
Benefits
Comp & perks- Medical, Vision, Dental
- Short- and Long-term insurance
- 6+ Days of Holidays Pay
- PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Comprehensive paid training program