East Brunswick, New jersey
Remote Nurse/Allied Health Professional Reviewer Job Opening in East Brunswick, New jersey - Healthcare Quality Strategies, Inc. (HQSI)
Job Description
Remote Nurse/Allied Health Professional Reviewer
Summary
HQSI is recruiting experienced remote medical review auditors to conduct utilization review (UR) of appeals using electronic medical records on a per case basis. The Medical Review Auditor performs the required work from a home office on their own schedule as long as established timelines are met. Work is performed through secure internet/cloud based portal. The ideal candidate should have 1-3 years UR experience and be a licensed RN, LPN or other allied healthcare professional. Experience in reviewing and/or coding clinical appeals is a PLUS. HQSI will provide a minimum of five cases to review per week, as review volume allows.
Remote Medical Review Auditors must have high-speed Internet access, a home computer with a current MS Windows operating system, the current browser version and/or one previous version for Chrome, Firefox, Internet Explorer, or Safari, and Adobe 9.0 or better
Key Responsibilities:
For each appeal, screen medical cases and write an accurate, clear and concise summary for review by physician reviewer. The summary must include thorough documentation of:
Reason for admission
Reason for presentation
Signs, symptoms, and physical exam
Laboratory and Radiology results
Physician Orders
Knowledge, Experience, Skills
Knowledge of:
Medical terminology
Evidence-based medical criteria and software programs
Medical record review and clinical data summarization
Current standards of medical practice
Performing work in a virtual environment
Experience in:
Medical record review and clinical abstraction
Application of screening criteria
Writing accurate, timely, and succinct correspondence
Complying with HIPAA/HITECH laws and regulations
Multitasking while meeting deadlines
Skills and requirements include:
Reliability and a commitment to meeting tight deadlines (24-48 -hour turnaround time on many assigned cases)
Computer proficiency (including MS Windows, MS Office, and the Internet)
Commitment to privacy, security and confidentiality of all medical chart documentation
Personal discipline to work remotely without direct supervision ? Self starter
Exemplary professionalism and attention to detail and completeness
Strong organization skills; interpersonal and customer service skills; written and oral communication skills; and problem solving skills
Able and willing to be responsive to fluctuating case loads
Professional and timely response expected to all telephone, Email and secure Email inquiries
Educational background:
RN, LPN or other allied healthcare professional with relevant certifications and/or licensure
Apply online at /careers , via fax at or via mail at:
Healthcare Quality Strategies, Inc.
557 Cranbury Road, Suite 21
East Brunswick, NJ 08816
Att: Human Resources
EEO/AAE
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