Medical Review Nurse – Rails

Medical Review Nurse – Rails

Requirements

• 5-7 years of relevant experience.
• Fully unencumbered nursing license required.
• Proficiency with computer and common office equipment, as well as with MS Office products.
• Must be able to multitask, be flexible, be organized, and have excellent oral and written communication skills as well as exceptional attention to detail.

Responsibilities

• Performs medical review of incoming charts to determine if additional medical information is needed.
• Collaborates with Physician(s) and other internal nursing staff members for chart review.
• Performs medical Quality Assurance (QA) on all charts in various process stages.
• Interfaces with Client’s Medical Department as well as the on-site provider.
• Contacts Examinee via telephone or email to clarify information necessary to complete the chart.
• Develops a very good understanding of the specific contract’s guidelines and addendums as required.
• Masters the various software programs specific to the functioning of the exam program.
• Implements and follows up on requests for further evaluation from the Examinee when required.
• Works closely with other departments to provide accurate and quality outcomes.
• Thoroughly cognizant of metrics and organizes workload to meet them.
• Consistently learns and applies codified state and federal regulations specific to particular contract(s).
• Serve as backup to other nurses for daily duties and assists with follow-up calls to facilities and Examinees as needed as well as other duties as assigned.
• Opportunity to travel and assist on medical mobile events as either a site lead and/or RN as work or personal schedule permit.
• May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain a specific level of knowledge pertaining to new developments, new task efforts, contract awards, and new policy requirements.
• Supports marketing and sales objectives and efforts as requested.
• Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training, and goals. Ensures safe operating conditions within an area of responsibility. Encourages co-workers to work safely. Identifies ‘close calls’ and/or safety concerns to supervisory personnel. Maintains a clean and orderly work area.
• Assists in the active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, and other mandated regulations/standards.
• May serve on the OSHA VPP, Safety, and Wellness Committees.

Preferred Qualifications

• COHN-S and/or CAOHC certifications
• Bachelor’s Degree with 5 years of relevant experience
• Flexibility and availability to travel and assist to support medical mobile events as either site lead and/or RN