KePRO

  • Lincoln,NE
KePRO Remote * (Lakeland,FL)
Feb 25, 2021
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. KEPRO is seeking resumes for a highly experienced professional. Note: An active LPN, or RN License is required for this role with experience in a clinical/hospital setting. This position is fully remote, candidates in EST or CST preferred. Summary Description Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with CMS NCQA, URAC and other regulatory standards. Accountabilities Reviews and interprets patient records and compares against criteria to determine medical necessity and...
KePRO Remote * (Modesto, CA, USA)
Feb 25, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. PASRR Level II Evaluator **HIRING FOR FULL-TIME, PART-TIME AND PRN** Summary Description Conducts face to face assessments for individuals with mental illness admitted to or residing in Medicaid certified hospitals or Nursing facilities. Provides recommendations for mental health treatment and appropriate placement as well as needed specialized services. Also, ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. Accountabilities Ensures accurate PASRR evaluations through accurate clinical assessment of the patient, relevant records and collateral sources of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental...
KePRO Remote * (Monterey, CA, USA)
Feb 25, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. PASRR Level II Evaluator **HIRING FOR FULL-TIME, PART-TIME AND PRN** Summary Description Conducts face to face assessments for individuals with mental illness admitted to or residing in Medicaid certified hospitals or Nursing facilities. Provides recommendations for mental health treatment and appropriate placement as well as needed specialized services. Also, ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. Accountabilities Ensures accurate PASRR evaluations through accurate clinical assessment of the patient, relevant records and collateral sources of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental...
KePRO Remote * (Sacramento, CA, USA)
Feb 25, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. PASRR Level II Evaluator **HIRING FOR FULL-TIME, PART-TIME AND PRN** Summary Description Conducts face to face assessments for individuals with mental illness admitted to or residing in Medicaid certified hospitals or Nursing facilities. Provides recommendations for mental health treatment and appropriate placement as well as needed specialized services. Also, ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. Accountabilities Ensures accurate PASRR evaluations through accurate clinical assessment of the patient, relevant records and collateral sources of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental...
KePRO Remote * (Colorado Springs, CO, USA)
Feb 25, 2021
Full-Time
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. KEPRO is seeking resumes for a highly experienced HCBS/LTSS professional. Accountabilities Performs all applicable review types as workload indicates, accurately and timely. Conduct reviews of Enrollees' long-term supports and services (LTSS) and/or Home and Community-Based Services (HCBS) needs. Act as clinical resource for eligible individuals and community agencies/providers. Monitor the provision and outcomes of LTSS and HCBS services including quality of outside agency documentation. Maintains current knowledge base related to LTSS/HCBS review and assessment processes and clinical practices related to the processes. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary....
KePRO Remote * (Boulder, CO, USA)
Feb 25, 2021
Full-Time
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. KEPRO is seeking resumes for a highly experienced HCBS/LTSS professional. Accountabilities Performs all applicable review types as workload indicates, accurately and timely. Conduct reviews of Enrollees' long-term supports and services (LTSS) and/or Home and Community-Based Services (HCBS) needs. Act as clinical resource for eligible individuals and community agencies/providers. Monitor the provision and outcomes of LTSS and HCBS services including quality of outside agency documentation. Maintains current knowledge base related to LTSS/HCBS review and assessment processes and clinical practices related to the processes. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary....
KePRO Remote * (Oklahoma, USA)
Feb 25, 2021
Part-Time
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.KEPRO is seeking resumes for a highly experienced professional. Clinical Reviewer Summary Description Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. Accountabilities Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services. Determines approval or initiates a referral to the physician consultant and...
KePRO Remote * (Charleston, WV, USA)
Feb 25, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. Clinical Assessor - RN Summary Description Seeking a Registered Nurse to work within the Aged and Disabled Waiver (ADW) and Pre-Admission Screen (PAS) programs in the Charleston, WV area. The ADW RN performs education and initial/re-evaluation assessments of Aged and Disabled Waiver members for the purpose of determining program medical eligibility. This position will cover Kanawha County. Benefits Remote based position (Work from home - must be able to cover assessments inKanawha County, WV) Competitive medical, dental and vision benefits Competitive 401k match Make your own schedule Day shift No Weekends or Holidays No on Call requirements Travel Reimbursement Cell Phone Reimbursement...
KePRO Remote * (Riverside, CA, USA)
Feb 25, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. PASRR Level II Evaluator **HIRING FOR FULL-TIME, PART-TIME AND PRN** Summary Description Conducts face to face assessments for individuals with mental illness admitted to or residing in Medicaid certified hospitals or Nursing facilities. Provides recommendations for mental health treatment and appropriate placement as well as needed specialized services. Also, ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. Accountabilities Ensures accurate PASRR evaluations through accurate clinical assessment of the patient, relevant records and collateral sources of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental...
KePRO Remote * (Harrisburg, PA, USA)
Feb 25, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. Internal Quality Specialist (Remote Opportunity) Accountabilities Responsible for utilizing data software and reports to monitor and track task management throughout operational departments. Interpret data, analyze results using techniques to creates reports for internal teams; utilizes scorecards, graphs, infographics and other methods to visualize data. Works closely with the appropriate staff to establish, maintain, and monitor performance measurement for Operations. Prepares and provides on a routine basis, quality and individualized and team task management summaries to supervisors and leadership. Provides guidance and expertise to "drive" project teams and see continuous quality improvement and...
KePRO Remote * (Harrisburg, PA, USA)
Feb 25, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. Accountabilities Collaborate with the Chronology and Claim/Risk Management nursing staff to ensure production of quality reports within the HRSA-established deadlines. Collaborate with the Administrative Assistant staff to ensure all tasks as assigned are completed timely and with attentiveness to detail. Collaborate with the Medical Director to ensure quality and timeliness of Expert Medical Reviewer (EMR) reporting. Assess and evaluate the daily work queue (Tickler) and adjust staffing schedules to ensure production of reports within the HRSA-established deadlines. Assist the Operations Manager (Ops Mgr.) with monthly claim audit duties. Assist the Ops Mgr. with monthly, quarterly, annual claim trend, and...
KePRO Remote * (Turlock, CA, USA)
Feb 24, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. PASRR Level II Evaluator **HIRING FOR FULL-TIME, PART-TIME AND PRN** Summary Description Conducts face to face assessments for individuals with mental illness admitted to or residing in Medicaid certified hospitals or Nursing facilities. Provides recommendations for mental health treatment and appropriate placement as well as needed specialized services. Also, ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. Accountabilities Ensures accurate PASRR evaluations through accurate clinical assessment of the patient, relevant records and collateral sources of individuals with suspected or confirmed mental illness to determine the presence of a Serious Mental...
KePRO Remote * (Pennsylvania, USA)
Feb 24, 2021
Full-Time
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.KEPRO is seeking resumes for a highly experienced professional. Quality and Performance Support Summary Description Responsible for monitoring and updating tools and processes to support quality and compliant practice in accordance with contract requirements. Maintains working knowledge of internal policies, procedures and services (both departmental and operational.) Prepares all related contract documents, mailings and reports to meet requirements for the contract. Work is performed under minimal supervision, and requires independent judgment and discretion. Accountabilities Reviews submitted contract compliance documents to determine if all required information is present and updates if/when additional information is needed. Accurate and timely submission of all...
KePRO Remote * (Lakeland, FL, USA)
Feb 22, 2021
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. KEPRO is seeking resumes for a highly experienced professional. Note: An active LPN, or RN License is required for this role with experience in a clinical/hospital setting. This position is fully remote, candidates in EST or CST preferred. Summary Description Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with CMS NCQA, URAC and other regulatory standards. Accountabilities Reviews and interprets patient records and compares against criteria to determine medical necessity and...