Clinical Claim Review RN – Medical Disability – Remote

About the position

Responsibilities
• Remain up to date with the contract requirements
• Use clinical judgement to ensure a clear, comprehensive, and concise exam documentation that is reflective of the patient’s service level conditions and in compliance to contract requirements
• Interpret and document diagnostic test results
• Educate and support provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
• Answer calls that come into the Clinical Operations Review queue regarding medical or specialty exams and provide exemplary service to providers with appointment questions
• Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high-risk intervention process
• Complete system generated tasks to process exam documentation
• Interface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol

Requirements
• Accredited Associate’s Degree in Nursing (ADN) OR Bachelor’s Degree in Nursing (BSN)
• Current RN license in your state of residency
• 2+ years of experience in a clinical environment as a Registered Nurse
• Experience working in an Electronic Medical Record system
• Understanding/knowledge of regulatory standards and their application to various examinations and documents
• Proficient computer skills including Microsoft Office programs and database experience
• Ability to work rotating weekends (approximately every 8 weeks)
• Distraction-free, dedicated space in home for home office
• Access to high-speed internet (cable, fiber optic)

Nice-to-haves
• Experience in an Intensive Care Unit or Emergency Room
• Prior authorization, utilization management/review experience
• Experience reviewing medical disability claims
• Knowledge or experience in clinical quality assurance
• Auditing and compliance
• Education of clinical staff
• Clinical documentation improvement
• Clinical experience in Neurological, Cardiovascular or Respiratory units
• ISO 9001 standards
• Healthcare regulatory and accreditation standards
• Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
• Military experience
• Proven ability to collaborate with providers to ensure quality patient outcomes

Benefits
• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution