REMOTE Quality Review Registered Nurse

MPF Federal

6d•$35•Remote

About The Position

Ready to Bring Your Acute Care Skills Home? Join Our Remote RN Team Supporting Our Military Communities! The statements listed below are not intended to be all inclusive of the duties and responsibilities of the position. Based on leadership decisions and business needs, “all other duties as assigned” will be expected for each position. Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. Conduct a clinical review of a variety of examination documentation, test results, assessments and information and, by corroborating via phone interview with Service Members and Veterans, provide a clear, comprehensive and concise final product. Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation. Collaborate with providers, Veterans, and Service Members via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes. Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs. Identify emergent behavioral health issues and initiate intervention when necessary. Remain up to date with the contract requirements Use clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patient’s service level conditions and in compliance to contract requirements Interpret and document diagnostic test results Educate and support providers, Veterans, and Service Members with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams, and provide exemplary service to providers with appointment questions Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high risk intervention process Complete system generated tasks to process exam documentation Interface via telephone (up to 75%) and e-mail with contracted providers, Veterans, and Service Members in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol If you're an experienced nurse with a calm voice, an eye for detail, and a heart for service, this is your moment to make a real difference. Apply now and be the steady hand guiding military families when they need it most... right from your home!

Requirements

Accredited Associate’s Degree in Nursing (ADN) OR Bachelor’s Degree in Nursing (BSN)
Current RN license in your state of residency
Ability to type 40 words per minute
5+ years of experience in a clinical environment as a Registered Nurse
Experience working in an Electronic Medical Record system
Understanding/knowledge of regulatory standards and their application to various examinations and documents
Proficient computer skills including Microsoft Office programs and database experience
Ability to work MTWRF 8:00am to 5:00pm CT OR 10:00am-7:00pm CT
Distraction-free, dedicated space in home for home office; this includes establishing or continuing regular child or dependent care arrangements
Access to high-speed internet (cable, fiber optic)
Must have a hard-wired Ethernet internet connection (Wi-Fi only, satellite, or radio internet is not acceptable)
Quiet, distraction-free home office space with a door for HIPAA compliance
Metrics-driven environment – you’ll need to meet quality, handle time, and documentation goals
Must be a U.S. Citizen
Ability to pass a Public Trust Background Check & Drug Screening per federal guidelines

Nice To Haves

Experience navigating Microsoft Teams
Home Health or Hospice care experience
Experience reviewing medical disability claims
Knowledge or experience in: Clinical quality assurance
Auditing and compliance
Education of clinical staff
Clinical documentation improvement
Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
Military experience

Responsibilities

Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams.
Conduct a clinical review of a variety of examination documentation, test results, assessments and information and, by corroborating via phone interview with Service Members and Veterans, provide a clear, comprehensive and concise final product.
Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation.
Collaborate with providers, Veterans, and Service Members via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes.
Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs.
Identify emergent behavioral health issues and initiate intervention when necessary.
Remain up to date with the contract requirements
Use clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patient’s service level conditions and in compliance to contract requirements
Interpret and document diagnostic test results
Educate and support providers, Veterans, and Service Members with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams, and provide exemplary service to providers with appointment questions
Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high risk intervention process
Complete system generated tasks to process exam documentation
Interface via telephone (up to 75%) and e-mail with contracted providers, Veterans, and Service Members in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol