Nurse Reviewer [Nigeria]

 

Nurse Reviewer

BCforward is seeking a highly motivated and experienced Nurse Reviewer for Remote

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Title: Nurse Reviewer
Expected contract duration: 12+ months with strong possibility of extension
Location: Remote

Summary
We are seeking a talented individual for a Nurse Reviewer who will be responsible for performing clinical reviews to determine if the medical record documentation supports the need for the service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined by review methodologies specific to the contract for which services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination.

Your role in our mission

• Reviews and interprets medical records and compares against criteria to determine appropriateness and reasonableness of care; apply critical thinking and decision making skills to determine if the medical record documentation supports the need for service while maintaining production goals and quality standards.
• Document decisions and rationale to justify review findings or no findings.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail and completed within contractual deadline.
• Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
• Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
• Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
• Recommends, tests and implements process improvements, new audit concepts, and technology improvements that will enhance production, quality, and client satisfaction

What we're looking for

• Demonstrated proficiency in computer skills, and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, etc.
• Active and unrestricted RN license required
• 5+ years clinical experience in an inpatient hospital setting required
• 2+ years utilization review experience or claims auditing required
• Experience using Milliman or InterQual criteria required

What you should expect in this role

• Home based position
• This position requires that you provide high speed internet connection and a work environment free from distractions
• Ability to work during normal business hours as this position requires frequent interactions with the team and other departments within the company
• May be required to work extended hours for special business needs
• May be required to travel at least 10% of time based on business needs

Who to contact: Tahura Khatoon.

About BCforward:
BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full-service personnel solutions organization. Headquartered in Indianapolis, Indiana, BCforward also operates numerous delivery centers across North America and India. We are currently the largest consulting firm and largest MBE certified firm in Indiana. Our uninterrupted growth has allowed BCforward to deliver uniquely configured IT staffing and project solutions for over years of catering to our customers' specific needs. BCforward currently maintains a team of over 5000 global resources. With our additional brand, Stafforward, together we have the capabilities to deliver services for a variety of industries in both public and private sectors which allows us to address your most challenging needs.
www.BCforward.com

Interested candidates please send resume in Word format Please reference job code 205281 when responding to this ad.

Employee Type

Contractor

Location

, AK (Onsite)

Job Type

Nurse

Experience

Not Specified

Date Posted

06/12/2023

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