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Clinical Reviewer

2 months ago


Detroit, Michigan, United States w3r Consulting Full time
Job Title: Clinical Reviewer

We are seeking a highly skilled Clinical Reviewer to play a critical role in ensuring the quality of patient care at w3r Consulting. As a key member of our team, you will be responsible for reviewing precertification admissions and concurrent reviews to determine the appropriateness of inpatient settings.

Key Responsibilities:
  • Review patient records and medical information to determine the need for inpatient care, ensuring compliance with established medical guidelines and protocols.
  • Collaborate with healthcare providers, facilities, and medical directors to ensure accurate and timely reviews, fostering strong relationships and open communication.
  • Enter and reference data via computer systems to support review decisions, utilizing expertise in medical terminology and InterQual knowledge.
  • Develop and maintain strong relationships with healthcare providers and facilities, promoting a culture of quality and excellence.
Requirements:
  • A registered nurse with a current Michigan license, possessing a strong foundation in patient care and medical knowledge.
  • An associate degree or nursing diploma, demonstrating a commitment to ongoing education and professional development.
  • At least two years of patient care experience, including triage, case management, or utilization review, with a proven track record of success.
  • Expertise in medical terminology and InterQual knowledge, with a strong understanding of medical guidelines and protocols.
  • Ability to work flexible hours, including some weekends and corporate holidays, with a focus on delivering high-quality results.
Top 3 Required Skills/Experience:
  • Two years of acute care experience with an unrestricted registered nurse license, demonstrating a strong foundation in patient care.
  • ICU/ER experience preferred or post-acute care experience in SNF/Rehab/LTACH settings, with a focus on delivering high-quality patient care.
  • InterQual/MCG or other utilization review experience, with a strong understanding of medical guidelines and protocols.
Additional Requirements:
  • Advanced computer skills, including 40+ WPM typing, with a focus on data entry and reference.
  • Excellent written and oral communication skills, with a strong ability to collaborate and communicate effectively.
  • Ability to work independently and as part of a team, with a focus on delivering high-quality results.