Our Client, a Leading Provider of Healthcare Delivery Systems and Solutions company, is looking for a Clinical Reviewer for their Remote/CA location. Responsibilities:

+ The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

+ Assures accuracy and timeliness of all applicable review type cases within contract requirements.

+ Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.

+ In collaboration with Supervisor, responsible for quality monitoring activities.

+ Maintains current knowledge base related to review processes and clinical practices.

+ Functions as providers' liaison for customer service issues and problem resolution.

+ Performs all applicable review types as workload indicates.

+ Fosters positive and pro...