Remote RN, Clinical Record Review

Managed Medical Review Organization•Novi, MI

8d•Remote

About The Position

We are searching for a new RN to join our team. Our Nurses enjoy the flexibility to work remotely and do not have face-to-face Patient contact. This position is performed in a home-office environment and requires great telephonic/customer service and documentation skills in addition to clinical experience. Please review the roles and responsibilities of this position below. Please complete all application questions and follow-up assessments. Incomplete applications will not be accepted. Upon receipt of a case, verify the presence of any real or perceived conflict of interest, consistent with corporate policy (Ref: Policy and Procedure- Conflict of Interest).

Requirements

Applicants must reside in: Michigan, Florida, Idaho, Texas, Minnesota or Illinois.
Requires great telephonic/customer service and documentation skills in addition to clinical experience.

Responsibilities

As applicable, based on the HCR service type requested, verify the appropriate service, Physician Reviewer Specialty, and review questions upon review of the case and the associated medical records
Maintain communication with the Physician Reviewer (as applicable) during the review process to ensure timely and accurate delivery of the review service being completed.
Verifies current credentials for the Physician Reviewer in the Core Connect. Verify that credentialing has not expired and is complete consistent with corporate policy (Ref: MMRO Credentialing Policy & Procedure).
Maintain communication, including but not limited to any delays in service, with the referring party as required for the case type being performed.
As applicable, discuss and review training material with Physician Reviewers.
Maintain policy and process requirements for State Mandated External Reviews, including the submission of all required correspondence and documentation consistent with state requirements.
Accurately and consistently document all required case activities in W5.
Accurately inputs Physician Reviewer cost and client charge into W5 for invoicing/payment by the Bookkeeper.
Quality review rough draft versions of HCR reports to ensure clinical quality and compliance, including but not limited to: clinical quality issues (i.e. clinical substantiation, clinical inconsistences, plan language compliance) incomplete reports, report inconsistencies, and grammar or typographical errors.
Communicate, verbally or in writing, with the Physician Reviewer, to remediate any quality issues identified, consistent with corporate policy.
Assist the Physician Reviewer, as applicable, in selecting and utilizing evidence-based criteria and support of clinical rationale.
Perform final review of HCR reports in preparation of submitting to client.
As applicable, participate in Physician Reviewer orientation/training programs, including the development of customized or individualized physician orientation and training programs.
As applicable, participate in the Quality Improvement Committee and/or participate in Quality Improvement Projects, as requested by the Quality Department.
Address ongoing quality issues with the Quality Department and suggest quality improvement initiatives, as deemed appropriate.
Seeks the advice of the Executive Medical Director, as needed, when performing assigned duties.