NURSE REVIEWER (R.N.) - REMOTE

Healthcare Quality Strategies, Inc. (HQSI) - Wilkes-Barre, PA

30+ days ago

NURSE REVIEWER (R.N.) - REMOTE

Healthcare Quality Strategies, Inc. (HQSI) was founded in 1982, with the mission of accelerating healthcare quality improvement through a collaborative and interactive process, within the healthcare community. Headquartered in East Brunswick, NJ, we are a small, vibrant not-for-profit organization offering business solutions designed to make health care safer, more accessible, more efficient and more effective.

Our URAC accredited Medical Review Services department is expanding. Opportunities for full-time, part-time or per diem Reviewers are now available with more traditional weekday schedules as well as weekend hours. (NOTE: These opportunities are only available for applicants within a short radius of the Wilkes Barre, PA or East Brunswick, NJ area. Occasional in-person staff meetings and trainings may be required.)

HQSI is recruiting experienced remote medical review Nurse Reviewers to conduct utilization review (UR) of appeals using electronic medical records The Medical Review Nurse performs the required work from a home office using a secure portal/desktop. The ideal candidate should have 1-3 years UR experience and be a licensed RN. Experience in reviewing and/or coding clinical appeals is a PLUS.

Key Responsibilities:

  • For each appeal, screen medical cases and write an accurate, clear and concise summary for review by physician reviewer. The summary must include thorough documentation of:

o Reason for admission

o Reason for presentation

o Signs, symptoms, and physical exam

o Laboratory and Radiology results

o Physician Orders

Knowledge, Experience, Skills

Knowledge of:

  • Medical terminology
  • Evidence-based medical criteria and software programs
  • Medical record review and clinical data summarization
  • Current standards of medical practice
  • Performing work in a virtual environment

Experience in:

  • Medical record review and clinical abstraction
  • Application of screening criteria such as InterQual and/or MCG
  • Writing accurate, timely, and succinct correspondence
  • Complying with HIPAA/HITECH laws and regulations
  • Multitasking while meeting deadlines

Skills and requirements include:

  • Reliability and a commitment to meeting tight deadlines (24-48 -hour turnaround time on many assigned cases)
  • Computer proficiency (including MS Windows, MS Office, and the Internet)
  • Commitment to privacy, security and confidentiality of all medical chart documentation
  • Personal discipline to work remotely
  • Exemplary professionalism and attention to detail and completeness
  • Strong organization skills; interpersonal and customer service skills; written and oral communication skills; and problem solving skills
  • Able and willing to be responsive to fluctuating case loads
  • Professional and timely response expected to all telephone, Email and secure Email inquiries

Educational background:

  • RN License in good standing
  • Coding and/or clinical documentation improvement knowledge or experience a plus
  • We offer a comprehensive suite of benefits for full time staff including: Medical, Dental and Vision Plans, Short and Long Term Disability Plans, Life Insurance, FSA, HRA, Pension Plan, 401(k) Plan, and a generous PTO program.

We look forward to receiving your cover letter and resume.

Job Type: Full-time

License:

  • Registered Nurse (RN) (Preferred)