Clinical Assessor - Field or Telephonic - (Charleston, TN)

KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over twenty million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional RN Clinical Field Assessor Summary Description The Medical RN Clinical Assessor reviews prior authorization requests for medical services. The reviewer is required to review clinical details, select the appropriate medical necessity review criteria, and determine if medical necessity is met. Clinical justification for approval or failure to meet criteria must be documented. Must possess a Nursing Degree (BSN preferred) and must have a valid WV RN License in good standing. Must have a min of three years nursing background in a medical setting. Must possess knowledge of medical codes., ICD-10, medical terminology, and clinical assessment and decision-making skills. Utilization Managerial background desired in addition to nursing background.