Remote RN: Clinical Records Review & QC

Managed Medical Review Organization

Minneota (MN)

Remote

USD 75,000 - 95,000

Full time

5 days ago

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Benefits offered by this job

Remote work flexibility

On-call rotation for weekends/holidays

Job summary

Managed Medical Review Organization seeks a licensed RN for a home-office, remote role focused on telephonic customer service and clinical documentation. The position emphasizes quality review, case management, and adherence to policy, with on-call requirements for weekends and holidays.

Applicants must reside in Michigan, Florida, Idaho, Texas, Minnesota, or Illinois and be available 12 pm–8 pm EST, Monday–Friday, with rotating on-call coverage.

Qualifications

Current unrestricted RN state license
Graduate from an accredited School of Nursing (BSN or ADN)
Thorough knowledge of computer operation and software applications
Minimum of two years in healthcare insurance review or QA in related roles

Responsibilities

Verify conflicts of interest per policy and respond accordingly
Review medical records for completeness for the requested service type
Maintain communication with the Physician Reviewer during the review process
Verify Physician Reviewer credentials and credentialing status
Document all required case activities in W5 accurately
Input Physician Reviewer costs and client charges into W5 for invoicing

Skills

Strong verbal and written comms

Proficient computer skills

Independent work capability

Education

BSN or ADN from an accredited nursing program

Current unrestricted RN state license

Tools

W5 system

Microsoft Office / general software

Job description

Applicants must reside in Michigan, Florida, Idaho, Texas, Minnesota, or Illinois and be available 12 pm–8 pm EST, Monday–Friday, with rotating on-call coverage.

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