Remote RN, Clinical Record Review

Managed Medical Review Organization; Novi (MI); À distance; USD 70 000 - 90 000; Plein temps

Résumé du poste

Managed Medical Review Organization is seeking a licensed RN to join our team for remote, home-office work. This role emphasizes telephonic customer service, accurate documentation, and clinical review of medical records with no face-to-face patient contact.

Applicants must reside in Michigan, Florida, Idaho, Texas, Minnesota or Illinois and possess strong credentialing oversight, communication, and policy-compliant review skills.

Responsabilités

• Verify conflict of interest per policy when a case is received
• Review service type, physician reviewer specialty and review questions with medical records
• Maintain communication with the Physician Reviewer to ensure timely, accurate delivery of review service
• Verify credentials for the Physician Reviewer and credentialing status per MMRO policy
• Maintain communication with referring party regarding delays and case type requirements
• Discuss and review training material with Physician Reviewers as applicable
• Ensure State Mandated External Reviews documentation complies with state requirements
• Accurately document all required case activities in W5 and input cost into W5 for invoicing

Description du poste

Applicants must reside in: Michigan, Florida, Idaho, Texas, Minnesota or Illinois.

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.

• 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).
• 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. 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.