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Clinical Claims Review RN - Telecommute

La Crosse, WI, United States

Posted on
Jun 30, 2020

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Theu00a0**MEMBERS ONLY**SIGN UP NOW***. family of businesses. As au00a0Clinical Claims Reviewu00a0Nurse,u00a0you can put your skills and talents to work, reviewing cases with treating physicians and other health care professionals to ensure our members receive the proper health services. This is a multifaceted role that is highly rewarding as your work is helping people live healthier lives.nu00a0nYouu2019ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.u00a0nu00a0n***Required schedule is Monday-Friday, 10:00am-7:00pm CENTRAL TIME.u00a0u00a0Weekend responsibilities also required on au00a0rotating basis.***nu00a0nPrimary Responsibilities:nnnNavigate 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 examsnConduct a clinical review of a variety of examination documentation, test results, assessments and information to provide a clear, comprehensive and concise final productnUtilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentationnCollaborate with providers via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposesnPossess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needsnIdentify emergent behavioral health issues and initiate intervention when necessarynRemain up to date with the contract requirementsnUse clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patientu2019s service level conditions and in compliance to contract requirementsnInterpret and document diagnostic test resultsnEducate and support provider with navigating and utilizing medical history information and prior disability claims when completing the appointment paperworknAnswer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams and provide exemplary service to providers with appointment questionsnIdentify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high risk intervention processnComplete system generated tasks to process exam documentationnInterface via telephone and e-mail with contracted providers in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocolu00a0nAnswer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams, and lab results and provide exemplary service to providers and patients with appointment questionsnMay flex into other assignments within Clinical Operations department utilizing nursing skills, as needednnnYouu2019ll 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.u00a0nnRequired Qualifications:nnnAccredited Associate's Degree in Nursing (ADN) OR Bacheloru2019s Degree in Nursing (BSN)nActive, unrestricted RN license in your state of residencenMinimum 3 years of experience in a clinical environment as a Registered NursenPosition requires the ability to use clinical judgement to interpret test resultsnUnderstanding of regulatory standards and their application to various examinations and documentsnExperience working in an Electronic Medical Record systemnProficient computer skills including Microsoft Office programs and database experiencenMust possess excellent verbal and written communication skillsnAnalytical thinking and team work skillsnAbility to perform detailed work with a high degree of accuracynnnu00a0Preferred Qualifications:nnnPrevious experience in an Intensive Care Unit or Emergency Room, or Behavioral Health environmentnKnowledge or experience in regards to: clinical quality assurance; auditing and compliance; education of clinical staff; Clinical Documentation Improvement; clinical experience with Neurological, Cardiovascular or Respiratory units; vision testing, audio testing, reviewing dental images; ISO 9001 standards, and/or other healthcare regulatory and accreditation standardsnExperience with TBI, PTSD and/or working with Veteransu00a0nNurse call line and/or triage line experienceu00a0nCollaborating with providers to ensure quality patient outcomesnKnowledge of CPT and ICD10 coding and phlebotomynMilitary experiencennnCareers with LHI.u00a0Our focus is simple. We're innovators in cost-effective health care management. And when you join our team, you'll be a partner in impacting the lives of our customers, and employees. We've joined OptumHealth, part of the **MEMBERS ONLY**SIGN UP NOW***. family of companies, and our mission is to help the health system work better for everyone. We're located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We're supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission-driven focus. For you, that means one incredible team and a singular opportunity to dou00a0your life's best work.(sm)nu00a0nOptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCareu2019s support services do not interfere with or control the practice of medicine by the medicalu00a0practices or any of their physicians.nu00a0n*All Telecommuters will be required to adhere to **MEMBERS ONLY**SIGN UP NOW***.u2019s Telecommuter Policy.u00a0nu00a0nu00a0nDiversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.nu00a0nOptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.nu00a0nJob Keywords:u00a0Clinical Claim Review RNu00a0 La Crosse, WI, Minneapolis, MN, Chicago IL, Telecommute, Telecommuternn,occupationalCategory:Certified Registered Nurse Anesthetist}

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