Requisition ID | 2024-10283 | # of Openings | 1 | Category | Operations | Location | US-GA-Lawrenceville |
We are seeking passionate and skilled RN's to serve as a Quality Review Manager, reviewing cases and ensuring all necessary information has been provided and is accurate before sending back to requestor.
This position is 100% remote.
The Quality Review Manager is responsible to work autonomously to complete full audit, review and approval of the following, but not limited to: Life Care Plans, Medical Cost Projections, Medicare Set-Aside Allocations, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews, initial and progress reports for medical or vocational case management files and other reports as needed within the scope of nursing practice and certifications. The Quality Review is responsible to monitor the overall quality of all the work products and effectively communicate with the planner team to include development of alternative treatment plans or recommendations for moving the file toward maximum resolution at the highest level of quality and timeliness possible.
ESSENTIAL JOB FUNCTIONS
ESSENTIAL MANAGERIAL RESPONSIBILITIES
Education and/or Experience
Associates degree required. Bachelor's degree in health-related field preferred. Three to five years Medicare Compliance preferred and a minimum of three years worker's compensation experience.
Certificates, Licenses, Registrations
Active unrestricted Registered Nursing license. Must have minimum active certification in Medicare Set-Asides; additional certification in Life Care Planning and/or Legal Nurse Consulting preferred.
QUALIFICATIONS
ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Examworks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans