Physician Adminsitered Drugs Project Lead
Company: KEPRO (The Keystone Peer Review Organization), Inc
Posted on: February 22, 2021
Physician Adminsitered Drugs Project Lead
Opportunity.Opportunities.JobCategory: Operations Staff
- Opportunity.OpportunityDetail.PostedLabel : February 12, 2020
- Assures accuracy and timeliness of all applicable review type
cases within contract requirements.
- Assesses, evaluates and addresses daily work load and queues;
adjusts work schedules daily to meet the workload demands of the
- Analyzes productivity of PAD reviewers.
- Identify PAD reviewers' orientation and continuous learning
needs, in collaboration with the Manager, develops, and implements
plans to address those identified learning needs.
- In collaboration with Manager, responsible for the quality
monitoring activities including identifying areas of improvement
and plan implementation of improvement areas.
- Maintains current knowledge base related to review processes
and clinical practices related to the review processes; functions
as the initial resource to PAD reviewers regarding all review
process questions and/or concerns.
- Functions as providers' liaison and contact/resource person for
provider customer service issues and problem resolution.
- Performs all applicable review types as workload
- Foster positive and professional relationships and act as
liaison with internal and external customers to ensure effective
working relationships and team building in order to facilitate the
- Attends training and scheduled meetings and for maintenance and
use of current/updated information for review.
- Cross trains and perform duties of other contracts within KEPRO
to provide a flexible workforce to meet client/customer needs. The
list of accountabilities is not intended to be all-inclusive and
may be expanded to include other duties that management may deem
necessary from time to time. Qualifications
- Education (general level if required) or specific
- Active unrestricted Pharmacy Tech, LPN, RN or other applicable
State and/or Compact State clinical license per contract
- Graduation from an accredited Diploma, Associates or Bachelor's
Degree Program Skills, Knowledge Abilities (SKA)
- Knowledge of InterQual criteria strongly preferred.
- Knowledge of current NCQA/URAC standards strongly
- Knowledge of the organization of medical records, medical
terminology, and disease process required.
- Strong clinical assessment and critical thinking skills
- Medical record abstracting skills required.
- Ability to work in a team environment.
- Flexibility and strong organizational skills needed.
- Must be proficient in MS Office and internet/web navigation
Experience (If needed, describe kind and amount)
- Minimum 3 years of clinical experience in an acute or
med-surgical environment required.
- Minimum of 2 years UR and/or Prior Authorization or related
- Minimum of 2 years LTC experience.
- For BH Programs: Minimum 3 years direct behavioral/mental
health experience in a clinical setting or other applicable State
and/or Compact State clinical experience or license per contract
- Previous workload management experience strongly preferred.
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 must have the ability to read and interpret
data and complex information and function in a team environment. In
addition, the employee is required to sit for extended periods of
time; key and/or control objects; occasionally lift and/or move
objects weighing up to 10 pounds; use a personal computer; safely
operate an automobile, travel throughout the state, and communicate
effectively with internal and external customers. The list of
accountabilities is not intended to be all-inclusive and may be
expanded to include other duties that management may deem necessary
from time to time. EOE AA M/F/Vet/Disability Equal Opportunity
Employer/Protected Veterans/Individuals with Disabilities The
contractor will not discharge or in any other manner discriminate
against employees or applicants because they have inquired about,
discussed, or disclosed their own pay or the pay of another
employee or applicant. However, employees who have access to the
compensation information of other employees or applicants as a part
of their essential job functions cannot disclose the pay of other
employees or applicants to individuals who do not otherwise have
access to compensation information, unless the disclosure is (a) in
response to a formal complaint or charge, (b) in furtherance of an
investigation, proceeding, hearing, or action, including an
investigation conducted by the employer, or (c) consistent with the
contractor's legal duty to furnish information. 41 CFR
Keywords: KEPRO (The Keystone Peer Review Organization), Inc, Denver , Physician Adminsitered Drugs Project Lead, Healthcare , Denver, Colorado
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