Clinical Claim Review RN - Medical Disability - Remote - Remote Eligible

Caring. Connecting. Growing Together.

Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. Conduct a clinical review of a variety of examination documentation, test results, assessments and information and, by corroborating via phone interview with Service Members and Veterans, provide a clear, comprehensive and concise final product. Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation. Collaborate with providers, Veterans, and Service Members via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes. Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs. Identify emergent behavioral health issues and initiate intervention when necessary.

Primary Responsibilities:

• Remain up to date with the contract requirements
• Use clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patient's service level conditions and in compliance with contract requirements
• Interpret and document diagnostic test results
• Educate and support providers, Veterans, and Service Members with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork
• Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams, and provide exemplary service to providers with appointment questions
• Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high risk intervention process
• Complete system generated tasks to process exam documentation
• Interface via telephone (up to 75%) and e-mail with contracted providers, Veterans, and Service Members in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Accredited Associate's Degree in Nursing (ADN) OR Bachelor's Degree in Nursing (BSN)
• Current, active Registered Nurse (RN) license
• 2+ years of experience in a clinical environment as a Registered Nurse
• Experience working in an Electronic Medical Record system
• Understanding/knowledge of regulatory standards and their application to various examinations and documents
• Proficient computer skills including Microsoft Office programs and database experience
• Ability to work MTWRF 12:00pm-9:00pm CT and Q 8 week Weekend Day rotation [1 day]
• Distraction-free, dedicated space in home for home office; this includes establishing or continuing regular child or dependent care arrangements
• Access to high-speed internet (cable, fiber optic)

Preferred Qualifications:

• Nurse call line and/or triage line experience
• Ability to type 40 words per minute
• Home Health or Hospice care experience
• Experience reviewing medical disability claims
• Knowledge or experience in:
• Clinical quality assurance
• Auditing and compliance
• Clinical documentation improvement
• Experience with Behavioral Health, TBI, PTSD and/or working with Veterans
• Military experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.