What are the responsibilities and job description for the RN Independent Dispute Resolution Entity (IDRE) Nurse position at Nexus?
Job Type
Full-time
Description
The IDRE Nurse position supports the Independent Review Organization (IRO) in completion of review / determination and quality assurance efforts of independent dispute resolutions for both the Federal and State level programs. All IDRE Nurses are responsible for conducting reviews / determinations and quality assurance checks including analyzing medical records and ensuring proper documentation is submitted and considered in the determination according to Federal or State guidance. Additionally, the IDRE Nurses ensure that details provided in the completed determination are well-supported with a robust rationale and present in the final decision.
Requirements
Major Duties and Responsibilities :
- Comprehension of medical / surgical modalities and imaging techniques
- Ability to analyze clinical documentation, and supporting documentation to ensure the quality of the of the final determination
- Audit and analyze patient records to ensure appropriateness of the determination
- Utilize pre-approved criteria / guidelines and plan language to validate appropriateness of the determination (Federal / State Guidelines)
- Ability to understand and analyze Federal / State guidance documentation
- Keeps current with regulation changes
- Perform a low to moderate amount of research on a case-by-case basis
- Conducts audit to ensure a high-quality, professional determination free of grammar and spelling errors is delivered to the client
- Responsible for amending reports, when necessary, with any additional clinical information provided
- Participates in an interdisciplinary health care team to achieve positive outcomes
- Ability to complete an average daily caseload of 65 disputes once released from training
- Requires regular and consistent attendance
- Other duties as assigned
Knowledge and Abilities Requirements :
Education / Credentials :
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All ProPeer team members may be required to perform duties outside of their normal responsibilities from time to time, as needed
