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Nurse Reviewer - Remote

Company: The Computer Merchant, Ltd
Location: Anchorage
Posted on: September 19, 2023

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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