Clinical Reviewer

Job Description

As a Clinical Reviewer, you will play a pivotal role in recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for your assigned and non-assigned post-acute care (PAC) facilities. You will work telephonically and collaborate with internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain a timely discharge plan. Your role will also involve acting as a clinical resource for unlicensed Post-Acute Care Coordinators, authorizing continued stay at SNF, IRF, LTACH and Home Health care using approved medical care guidelines and working on additional duties such as participating in performance improvement activities, contributing to ongoing quality assessment/improvement activities, and implementing standardized operational processes.

Hard Skills

• 2 years of concurrent review experience
• 2 years of utilization review/management experience
• Case management experience (Preferred)
• Transition-of-care experience (Preferred)
• Comfortable speaking with providers/offices via phone (Preferred)
• Interqual experience (Preferred)
• Milliman/MCG experience (Preferred)

Soft Skills

• Excellent negotiation skills
• Influencing skills
• Problem-solving skills
• Decision-making skills
• Excellent communication (verbal/written)
• Organizational skills
• Interpersonal skills
• Ability to work independently
• Sound clinical judgment
• Critical thinking skills
• Strong commitment to quality and standards

Job Type

This is a Contract-to-Hire position with a duration of 12 Month(s).

Work Site

This is a fully remote position.

Work Environment

You will have a typical work schedule with occasional evening and weekend coverage based on business needs. This role is a work-from-home position with equipment provided. The first 4 weeks are dedicated to training (Monday-Friday 8:00am-4:30pm EST) and it is mandatory to attend all training days. After training, the working hours will be Tuesday to Saturday 11am to 8pm EST.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.