Clinical Quality Assurance Nurse Auditor (32292)

ExamWorks•Redding, CA

1d•$34 - $35•Remote

About The Position

ExamWorks is seeking a detail-oriented and motivated Remote Clinical Quality Assurance Nurse Auditor to join their team. This role is ideal for a Registered Nurse (RN) with Critical Care and ER experience who is looking to transition away from bedside care while still utilizing their clinical skills from home. The position ensures that reports are completed with the highest quality and integrity, adhering to all client contractual agreements, regulatory agency standards, and federal/state mandates. The Nurse Auditor will handle quality assurance questions and provide support to the Quality Assurance Department.

Requirements

Registered Nursing license required.
Must hold and maintain an unencumbered Registered Nursing license.
Must have experience in Emergency Room and Critical Care settings.
Must have strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values.
Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
Must be a qualified typist with a minimum of 40 W.P.M.
Must be able to operate a general computer, fax, copier, scanner, and telephone.
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
Must possess excellent skills in English usage, grammar, punctuation and style.
Ability to follow instructions and respond to upper management’s directions accurately.
Demonstrates accuracy and thoroughness.
Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
Must be able to work independently, prioritize work activities and use time efficiently.
Must be able to maintain confidentiality.
Must be able to demonstrate and promote a positive team-oriented environment.
Must be able to stay focused and concentrate with frequent interruptions.
Must be able to work well under pressure and/or stressful conditions.
Must possess the ability to manage change, delays, or unexpected events appropriately.
Demonstrates reliability and abides by the company attendance policy.
Must maintain a professional and clean appearance at all times consistent with company standards.

Nice To Haves

Bachelor degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience.
Experience with medical terminology, critical care, medical specialties and treatment protocols required.

Responsibilities

Evaluate clinical information received from hospital records.
Ensure reports are completed with the highest quality and integrity.
Ensure all work is in full compliance with client contractual agreements, regulatory agency standards, and/or federal and state mandates.
Handle quality assurance questions and provide overall support to the Quality Assurance Department.
Evaluate clinical information received and write/review various reports including Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice, and Medical Summary Statements.
Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews.
Ensure clear, concise, evidence-based rationales are provided in support of all recommendations and/or determinations.
Ensure all client instructions and specifications have been followed and that all questions have been addressed.
Ensure each review is supported by clinical citations and references when applicable and verify that all references cited are current and obtained from reputable medical journals and/or publications.
Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
In IME or Peer Review cases, ensure the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
Verify that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
Ensure the provider credentials and signature are adhered to the final report.
Identify any inconsistencies within the report and contact the Peer Reviewer to obtain clarification, modification, or correction as needed.
Contact the appropriate person to recover any missing documentation or verify charges.
Assist in the resolution of customer complaints and quality assurance issues as needed.
Ensure all federal ERISA and/or state mandates are adhered to at all times.
Provide insight and direction to management on consultant quality, availability, and compliance with all company policies and procedures and client specifications.
Promote effective and efficient utilization of company resources.
Participate in various continuing education requirements and/or training activities.