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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 quality and cost-efficient home health care services while maintaining compliance. Proficient in coordinating patient care with a multi-disciplinary team and conducting thorough reviews of clinical information.
Highest-signal resume keywords
State Licensure As A LPN Or RNUtilization Management ExperienceUtilization Management Or Case Management CertificationWord Processing And Spreadsheet ProficiencyDetail-Oriented And Organized
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ManagementPatient Treatment File AuditingConcurrent Review Of Clinical InformationPrecertification Request ReviewPatient Care Coordination
Soft Skills
Team PlayerEnthusiasticDedicatedOrganizational SkillsInterpersonal Skills
Tools & Technologies
Word Processing ProgramsSpreadsheet Programs
Certifications & Qualifications
Utilization Management CertificationCase Management Certification
Industry Keywords
Home Health CareCompliancePatient CareMedical Necessity
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
- Prevent unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare
- 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
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
- Ability to stay organized and interact well with others in any situation
- Detail-oriented, dedicated, enthusiastic, and team-player qualities 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