Medical Reviewer – Contractor – Remote in Nashville, TN

Medical Reviewer - Contractor -Remote - Kepro - Nashville, TN - work from home jobCompany: KeproJob description: Job Description:Medical Reviewer (Remote)• Are you an experienced Medical 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 Acentra Health team? If so, you might be our next new team member! • This is a contract position* Why us? Acentra Health 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 Acentra Health, 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 Acentra Health. 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:• Prepare independent reviews of medical services appeals• Review records, prepare and submit all reviews in keeping with the TennCare/Acentra Health contractual due dates.These may include appeals by TennCare members, CoverKids, members, Department of Intellectual & Developmental Disabilities clients, and Department of Commerce & Insurance appeals from TennCare providers. • Critically evaluate the application of guidelines and protocols by the TennCare managed care organizations, dental benefits manager, and pharmacy benefits manager to the individual enrollee's appeal. Take into consideration TennCare Rules of Medical Necessity, standards of care, evidence-based medicine, and hierarchy of evidence.• Review relevant peer reviewed research and evidence-based sources as needed• Edit Medical Necessity Reviews authored by other reviewers• Provide expert medical witness testimony for the State in appeals hearings and consult with the assigned TennCare attorney prior to the hearing as needed• Participate in quality assurance activities for medical necessity reviews and hearing outcomes• Regularly review relevant topics via peer reviewed articles and evidence-based sources to identify changes in medical practice, treatments, and medications• Work with medical, nursing, and administrative staff to identify matters needing shared attention• May primarily work remotely but must be available onsite to the client as contractually requiredThe list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.What you'll need:Required Qualifications• M.D. or D.O., eligible for or with current non-restricted license to practice medicine by the Tennessee Board of Medical Examiners. • Current board certification in a clinical specialty is required. Internal medicine, pediatrics, or family medicine preferred• Working knowledge of quality assurance and utilization review is required. Knowledge, Skills, Abilities• Ability to work effectively with a diversity of personalities. Must be approachable, show respect for others, and a consensus builder.• Adaptable with strong collaborative management style, a creative thinker with high energy and enthusiasm, and a team player who promotes the concepts of people working together. • Excellent writing skills and proficient with MS Office SuiteExperience• 5+ years of clinical practice. • Experience with Medicaid/Medicare• Prior managed care/utilization review work experienceThank 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 Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~The Acentra Health Talent Acquisition TeamMental and Physical RequirementsThe 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/DisabilityAcentra Health 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.Expected salary:Location: Nashville, TNJob date: Fri, 23 Jun 2023 03:10:30 GMTApply for the job now! Apply tot his job