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 Apply tot his job