Applicants must reside in: Michigan, Florida, Idaho, Texas, Minnesota or Illinois.<br><br>We are searching for a new RN to join our team. Our Nurses enjoy the flexibility to work remotely and do not have face-to-face Patient contact. This position is performed in a home-office environment and requires great telephonic/customer service and documentation skills in addition to clinical experience. Please review the roles and responsibilities of this position below. Please complete all application questions and follow-up assessments. Incomplete applications will not be accepted.<br><br><ul><li>Upon receipt of a case, verify the presence of any real or perceived conflict of interest, consistent with corporate policy (Ref: Policy and Procedure- Conflict of Interest).</li><li>As applicable, based on the HCR service type requested, verify the appropriate service, Physician Reviewer Specialty, and review questions upon review of the case and the associated medical records</li><li>Maintain communication with the Physician Reviewer (as applicable) during the review process to ensure timely and accurate delivery of the review service being completed.</li><li>Verifies current credentials for the Physician Reviewer in the Core Connect. Verify that credentialing has not expired and is complete consistent with corporate policy (Ref: MMRO Credentialing Policy & Procedure).</li><li>Maintain communication, including but not limited to any delays in service, with the referring party as required for the case type being performed.</li><li>As applicable, discuss and review training material with Physician Reviewers.</li><li>Maintain policy and process requirements for State Mandated External Reviews, including the submission of all required correspondence and documentation consistent with state requirements.</li><li>Accurately and consistently document all required case activities in W5.</li><li>Accurately inputs Physician Reviewer cost and client charge into W5 for invoicing/payment by the Bookkeeper.</li><li>Quality review rough draft versions of HCR reports to ensure clinical quality and compliance, including but not limited to: clinical quality issues (i.e. clinical substantiation, clinical inconsistences, plan language compliance) incomplete reports, report inconsistencies, and grammar or typographical errors.</li><li>Communicate, verbally or in writing, with the Physician Reviewer, to remediate any quality issues identified, consistent with corporate policy.</li><li>Assist the Physician Reviewer, as applicable, in selecting and utilizing evidence-based criteria and support of clinical rationale.</li><li>Perform final review of HCR reports in preparation of submitting to client.</li><li>As applicable, participate in Physician Reviewer orientation/training programs, including the development of customized or individualized physician orientation and training programs.</li><li>As applicable, participate in the Quality Improvement Committee and/or participate in Quality Improvement Projects, as requested by the Quality Department.</li><li>Address ongoing quality issues with the Quality Department and suggest quality improvement initiatives, as deemed appropriate.</li><li>Seeks the advice of the Executive Medical Director, as needed, when performing assigned duties.</li></ul>
