Nurse Reviewer

Overview

If you are an RN who is interested in contributing to a dynamic, values-oriented workplace, you'll fit right in as a Nurse Reviewer with ExamWorks Compliance Solutions (ECS).

The Nurse Reviewer works autonomously to review claims and develop any and/or all of the following: Life Care Plans, Medical Cost Projections, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews and other reports as needed within their scope of licensing and certifications.

This is a full-time, 100% remote position with a schedule of Monday-Friday, 8:30am - 5:00pm EST. 

Responsibilities

• Collects, reviews and analyzes health data from medical records and/or other sources as provided.
• Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care.
• Works autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed.
• Maintain a quality work product evidenced by acceptable quality scores/score cards.
• Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company.
• Attend all scheduled conference calls as mandated by management.
• Maintain any required credentials and adhere to all codes of ethics required by these credentials.
• Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times.
• Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
• Perform professional duties as assigned by the Manager or upper management.

Qualifications

Education and/or Experience

Associates degree required. Bachelor’s degree in health-related field preferred. A minimum of two years workers’ compensation and/or case management experience preferred.

Certificates, Licenses, Registrations

Active unrestricted Nursing license (including but not limited to RN, NP LVN, LPN). Certification in Medicare Set Asides and/or certifications in Life Care Planning or Legal Nurse Consulting encouraged.       

• Knowledge of the disability and workers' compensation industry including rules and regulations and a full understanding of Medicare rules and regulations.
• Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
• Must have adequate knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Ability to demonstrate critical thinking and problem-solving skills.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Ability to concentrate and multitask in a fast-paced work environment.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Must be able/willing to work on a flexible schedule when needs arise.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Demonstrates reliability and abides by the company attendance policy.
• Ability to read, analyze and interpret common to complex correspondence, medical records, various reporting records, legal contracts and/or related case documents.
• Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
• Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.
• Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.

ECS was formed in 2014 from the acquisition and consolidation of two pillars within the Medicare Secondary Payer (MSP) compliance industry: Gould & Lamb, providers of MSP compliance and reporting services, and MedAllocators/Ability Services Network, a national provider of MSP compliance and case management. Launched as Examworks Clinical Solutions, the new company offered unprecedented, integrated services aimed at managing high dollar complex Medicare, medical, and pharmaceutical claims. In May 2020, the organization name was changed to ExamWorks Compliance Solutions. A single word change, but one that truly reflects the core of what is offered by ECS. Today, our mission remains focused on providing the most comprehensive, creative, and customizable compliance and reporting solutions for the marketplace. 

ECS is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

ExamWorks Compliance Solutions offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.