Nurse Reviewer - Remote
Company: The Computer Merchant, Ltd
Location: Anchorage
Posted on: September 19, 2023
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Job Description:
JOB TITLE:Nurse Reviewer - RemoteJOB LOCATION: RemoteWAGE
RANGE*: $30hr to $32hrJOB NUMBER: 23-01396MUST HAVE JOB SKILLS:JOB
DESCRIPTIONWe are seeking a talented individual for a Nurse
Reviewer who will be responsible for performing clinical reviews to
determine if the medical record documentation supports the need for
the service based on clinical criteria, coverage policies, and
utilization and practice guidelines as defined by review
methodologies specific to the contract for which services are being
provided. This involves accessing proprietary systems to audit
medical records, accurately documenting findings and providing
policy/regulatory support for determination.Your role in our
missionReviews and interprets medical records and compares against
criteria to determine appropriateness and reasonableness of care;
apply critical thinking and decision making skills to determine if
the medical record documentation supports the need for service
while maintaining production goals and quality standards.Document
decisions and rationale to justify review findings or no
findings.Determines approval or initiates a referral to the
physician consultant and processes physician consultant decisions
ensuring reason for the denial is described in sufficient detail
and completed within contractual deadline.Performs prior
authorization, precertification, and retrospective reviews and
prepares decision letters as needed in support of the utilization
review contractAssists management with training new Nurse Reviewers
to include daily monitoring, mentoring, feedback and
education.Maintains current knowledge of clinical criteria
guidelines and successfully completes required CEUs to maintain RN
licenseResponsible for attending training and scheduled meetings to
enhance skills and working knowledge of clinical policies,
procedures, rules, and regulations.Actively cross-trains to perform
reviews of multiple claim types to provide a flexible workforce to
meet client needs.Recommends, tests and implements process
improvements, new audit concepts, and technology improvements that
will enhance production, quality, and client satisfactionWhat we're
looking forDemonstrated proficiency in computer skills, and typing,
i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet
browsers, etc.Active and unrestricted RN license required5+ years
clinical experience in an inpatient hospital setting required2+
years utilization review experience or claims auditing
requiredExperience using Milliman or InterQual criteria
requiredWhat you should expect in this roleHome based position and
you must have a work location within the continental USThis
position requires that you provide high speed internet connection
and a work environment free from distractionsAbility to work during
normal business hours as this position requires frequent
interactions with the team and other departments within the
companyMay be required to work extended hours for special business
needsEqual Opportunity Employer Veterans/Disabled* While an hourly
range is posted for this position, an eventual hourly rate is
determined by a comprehensive salary analysis which considers
multiple factors including but not limited to: job-related
knowledge, skills and qualifications, education and experience as
compared to others in the organization doing substantially similar
work, if applicable, and market and business considerations.
Benefits offered include medical, dental and vision benefits;
dependent care flexible spending account; 401(k) plan; voluntary
life/short term disability/whole life/term life/accident and
critical illness coverage; employee assistance program; sick leave
in accordance with regulation. Benefits may be subject to generally
applicable eligibility, waiting period, contribution, and other
requirements and conditions.
Keywords: The Computer Merchant, Ltd, Anchorage , Nurse Reviewer - Remote, Healthcare , Anchorage, Alaska
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