Remote RN, Clinical Records Review & QA (12–8 EST)

Managed Medical Review Organization, Inc.; Novi (MI); Remote; USD 65,000 - 90,000; Full time

Job summary

Managed Medical Review Organization, Inc. is seeking an experienced RN to join our team in a remote, home-office capacity.

The role emphasizes telephonic/customer service, accurate documentation, and clinical review of cases. Candidates must reside in Michigan, Florida, Idaho, Texas, Minnesota or Illinois, and be able to work 12 pm - 8 pm EST, Monday through Friday, with rotating on-call weekends and holidays.

Qualifications

• Current unrestricted RN license in state of residence.
• Graduated from an accredited School of Nursing with BSN or ADN.
• Proficient in computer operations and related software.
• Minimum 2 years in healthcare insurance (appeals/grievances, case management, or QA).
• Ability to work independently and maintain confidentiality.
• Strong verbal and written communication skills; MLA/NLM familiarity.
• Must work 12 pm–8 pm EST, Mon-Fri with rotating on-call on weekends/holidays.

Responsibilities

• Verify conflicts of interest per policy.
• Review medical records for service type, reviewer specialty, and questions.
• Maintain communication with Physician Reviewer for timely reviews.
• Verify Physician Reviewer credentials and expiration per policy.
• Document all case activities in W5 accurately.
• Input Physician Reviewer cost and client charges into W5 for invoicing.
• Quality review rough drafts of HCR reports for clinical quality and compliance.
• Remediate quality issues with Physician Reviewer as needed.
• Assist in selecting evidence-based criteria and rationale.
• Perform final review of HCR reports for client submission.
• Participate in orientation/training programs for physicians.
• Join Quality Improvement Committee/projects and suggest improvements.
• Address ongoing quality issues with the Quality Department.

Skills

Communication skills

Confidentiality

Independent worker

Telephone/customer service

Documentation skills

Education

Bachelor of Science in Nursing (B.S.N.)

Associate Degree in Nursing (A.D.N.)

Accredited School of Nursing

Tools

W5

Job description

Managed Medical Review Organization, Inc. is seeking an experienced RN to join our team in a remote, home-office capacity.

The role emphasizes telephonic/customer service, accurate documentation, and clinical review of cases. Candidates must reside in Michigan, Florida, Idaho, Texas, Minnesota or Illinois, and be able to work 12 pm - 8 pm EST, Monday through Friday, with rotating on-call weekends and holidays.