Clinical Reviewer (RN, LPN)

  • Kepro
  • Remote
  • May 18, 2021
Registered Nurse, Licensed Practical Nurse

Job Description

Clinical Reviewer

  • Are you an experienced Clinical Reviewer looking for a new challenge?
  • 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:

Kepro’s Absence Management Team is seeking a Disability Clinical Reviewer to support our Family Medical Leave Administration (FML) Product. DCM is responsible for processing FML medical certifications to determine if employee is eligible for FML leave under federal regulations and making leave determination based on medical guidelines.

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: 

  • Maintain a comprehensive knowledge of Family Medical Leave Act (FMLA) and related laws in all 50 states to efficiently administer our customers' FMLA and related policies.
  • Review medical certification documents under federal & state regulations to determine eligibility for protected leave of absence.
  • Meet production and quality goals set by the Absence Management Department.
  • Provide accurate, professional and timely responses to communications from internal and external clients.
  • Serve as an internal reference to the team for certification requirements and processing.
  • Contact Medical Providers to obtain and establish medical facts supporting the need for leave.
  • Correspond with clients regarding leave status and assist with decision-making.
  • Compose and send client-specific letters and emails regarding final decisions.
  • Provide innovative ideas that can support the ongoing growth of the Absence Management Department.
  • Support management with special projects as necessary.

What you’ll need:

Required Qualifications

  • Active RN license, LPN, or Master’s Degree in Behavioral Health or Human Resources Management.
  • Proficient in Microsoft Office Suite, Adobe, and web navigation.
  • Stable work history required.
  • Previous experience in absence management including thorough knowledge of Family Medical Leave Federal and State regulations and experience reviewing short-term disability claims, preferred.

Knowledge, Skills, Abilities

  • Demonstrate reliable and consistent attendance and is dependable.
  • Effective written and verbal communication skills.
  • The ability to think critically by gathering information, evaluating options and implementing the best solution.
  • Focus on achieving goal-oriented results.
  • Can make independent decisions and solve problems on your own.
  • Strong attention to detail, thoroughly executing tasks with accuracy and precision.
  • Efficient task management and ability to prioritize multiple projects.
  • Excellent customer services skills required.

Experience 

  • 5-7 years of clinical or professional experience preferred.
  • Previous experience in absence management including thorough knowledge of Family Medical Leave Federal and State regulations and experience reviewing short-term disability claims, preferred.

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.

Kepro offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please.Visit our website at www.Kepro.com for more information on the Kepro Family of Companies.

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