🪄 Skills: Communication SkillsAnalytical SkillsCollaboration
Requirements:
Active, unrestricted RN license (or LPN/Social Worker as per contract requirements).
Bachelor's Degree in a related field from an accredited institution.
Strong clinical assessment and critical thinking skills.
Knowledge of medical records organization, medical terminology, and disease processes.
Excellent written and verbal communication skills.
Experience in medical record abstracting.
Responsibilities:
Ensure the accuracy and timeliness of reviews for all applicable case types within contract requirements.
Assess and manage daily workload and queues, adjusting work schedules as needed to meet departmental demands.
Collaborate with the supervisor to conduct quality monitoring activities, identify areas for improvement, and implement strategies to address these areas.
Maintain an up-to-date knowledge base related to clinical review processes and serve as the initial resource for other nurse reviewers.
Act as a liaison for providers, addressing customer service issues and ensuring problem resolution.
Perform reviews for all applicable case types as required by workload demands.
Foster positive relationships with internal and external stakeholders to enhance team effectiveness and the review process.
Attend ongoing training sessions and meetings to stay updated on review protocols and industry practices.
Cross-train in other contracts to maintain workforce flexibility in response to client needs.