Please note that this position is
no longer available.
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Nurse Reviewer
OH - Westerville
The Nurse Reviewer works as part of our wholly owned subsidiary, Permedion, which located in Westerville, OH.
Essential Functions:
- Performs retrospective chart review per contract specifications
- Collects additional data as necessary to evaluate request
- Applies appropriate criteria, such as Milliman Care Guidelines or InterQual
- Utilizes clinical expertise to approve services or refer requests to a physician for review.
- Prepares letters to summarize retrospective review activity.
- Evaluates, identifies, and reports on, quality of care issues.
- Communicates with health care professionals as a liaison regarding contract/review specifications and requirements.
- Relates any questions or concerns that cannot be addressed to Project Manager.
- Participates on quality improvement teams, offers quality improvement suggestions on project protocols and processes, facilitates quality improvement plan development and implementation as requested, both internally and with external customers.
- Participates in the project data analysis, reporting, and feedback processes.
- Participates in presentations and community outreach activities as assigned.
- Performs other job related duties as assigned and as appropriate to educational and/or professional background.
Qualifications:
- Active RN Licensure and minimum 5 years clinical experience
- Demonstrated effective written and oral communication skills.
- Demonstrated computer skills.
- Demonstrated ability to analyze and evaluate medical information.
- Demonstrated customer service skills.
- Demonstrated experience in medical review, chart audits, and quality improvement processes.
- Willingness to travel 10% (nationally)
The Nurse Reviewer works as part of our wholly owned subsidiary, Permedion, which located in Westerville, OH.
Essential Functions:
- Performs retrospective chart review per contract specifications
- Collects additional data as necessary to evaluate request
- Applies appropriate criteria, such as Milliman Care Guidelines or InterQual
- Utilizes clinical expertise to approve services or refer requests to a physician for review.
- Prepares letters to summarize retrospective review activity.
- Evaluates, identifies, and reports on, quality of care issues.
- Communicates with health care professionals as a liaison regarding contract/review specifications and requirements.
- Relates any questions or concerns that cannot be addressed to Project Manager.
- Participates on quality improvement teams, offers quality improvement suggestions on project protocols and processes, facilitates quality improvement plan development and implementation as requested, both internally and with external customers.
- Participates in the project data analysis, reporting, and feedback processes.
- Participates in presentations and community outreach activities as assigned.
- Performs other job related duties as assigned and as appropriate to educational and/or professional background.
Qualifications:
- Active RN Licensure and minimum 5 years clinical experience
- Demonstrated effective written and oral communication skills.
- Demonstrated computer skills.
- Demonstrated ability to analyze and evaluate medical information.
- Demonstrated customer service skills.
- Demonstrated experience in medical review, chart audits, and quality improvement processes.
- Willingness to travel 10% (nationally)
