Utilization Review Nurse- $26.50-$28.50/hr

TEKsystems•Raleigh, NC

3d•$27 - $29•Remote

About The Position

This remote role is responsible for ensuring case reports meet high standards of quality and integrity and comply with client contractual agreements, regulatory agency standards, and federal and state mandates. The nurse performs quality assurance reviews of peer review reports and related correspondence, checks that recommendations are supported by clear evidence-based rationales and appropriate citations, and confirms that client instructions, specialty requirements, credentials, attestations, and report standards are satisfied. The position also supports the Quality Assurance Department by resolving report inconsistencies, assisting with client complaints and quality issues, advising management on consultant quality and compliance, and participating in training. The position is contract-to-hire and based out of Raleigh, NC, but is fully remote. After training, the schedule is flexible Monday through Friday between 7:00 a.m. and 8:30 p.m. EST. Pay is non-negotiable at $28.50 per hour for Registered Nurses and $26.50 per hour for LPNs/LVNs.

Requirements

Must be a Registered Nurse or LPN/LVN, as indicated by the role's stated pay categories.
Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values.
Qualified typist with a minimum typing speed of 40 W.P.M.
Full understanding of HIPAA regulations and compliance.
Ability to operate a general computer, fax machine, copier, scanner, and telephone.
Knowledge of multiple software programs, including Microsoft Word, Outlook, Excel, and the Internet.
Exceptional communication skills.
Ability to follow instructions and respond accurately to management directions.
Accuracy and thoroughness, with the ability to monitor one's work and promote quality.
Ability to work independently, prioritize activities, and use time efficiently.
Ability to maintain confidentiality.
Ability to demonstrate and promote a positive, team-oriented environment.
Ability to stay focused and concentrate under normal or heavy distractions.
Ability to work well under pressure or stressful conditions.
Ability to manage changes, delays, and unexpected events appropriately.
Ability to follow company policies and procedures, including policies in effect at hire and those added or changed subsequently.

Responsibilities

Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews.
Confirm that recommendations and determinations have clear, concise, evidence-based rationales.
Verify that client instructions and specifications have been followed and all questions addressed.
Check that reviews are supported by clinical citations and references when applicable, and that references are current and from reputable medical journals or publications.
Ensure reports meet company standards for content, format, and professional appearance.
Confirm the appropriate board specialty reviewed each case as required by client specifications or state mandates, and that this is accurately documented in the report.
Verify that peer reviewers attest only to facts and that there is no evidence of a conflict of interest.
Ensure provider credentials and signatures are included in the final report.
Identify report inconsistencies and contact peer reviewers for clarification, modification, or correction as needed.
Assist with resolving client complaints and quality assurance issues.
Ensure compliance with federal ERISA and state mandates.
Provide management with insight and direction regarding consultant quality, availability, and compliance with company policies, procedures, and client specifications.
Promote effective and efficient use of company resources.
Participate in educational and training activities as required.
Perform other duties as assigned.