Remote RN: Clinical Records Review & Quality Oversight

Managed Medical Review Organization; Novi (MI); Remote; USD 70,000 - 90,000; Full time

Job summary

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.

Responsibilities

• 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

Job description

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.