MedRisk

Medical Reviewer

• A Clinical Reviewer and Tele-Services Clinician is responsible for reviewing medical records, patient information, and treatment plans to ensure compliance with clinical guidelines and standards.
• Provide tele-services, such as telemedicine or teletherapy, to patients remotely.
• Applies MedRisk's telerehabilitation and consultation program inclusion guidelines to assigned cases to determine eligibility and appropriateness.
• Execute PT/OT evaluation and treatment consistent with telerehabilitation clinical guidelines.
• Document telerehabilitation visits and consultation in a manner consistent with company policies and department procedures.
• Perform telephonic outreach to patient, in-clinic provider, payor and physician when needed, or as requested.
• Document all communications with case stakeholders (adjusters, case managers, in-clinic providers).
• Initiates review for requested service upon system referral.
• Reviews each case and formulates recommendations through use of established medical criteria and clinical judgment.
• Contacts the treating practitioner for additional information or clarification, when necessary.
• Conducts ongoing review(s) of active cases regarding the need for continued services or treatment.
• Complies with all established policies and procedures.
• Attends meetings and trainings.