United States Other 1 week ago

About MPRO

Come join the MPRO team! MPRO is Michigan’s Medicare-designated Quality Improvement Organization. We are both a Cool Place to Work (Crain’s Detroit Business) for the last 4 years and one of the Best Places to Work in Healthcare as judged by Modern Healthcare. As a nonprofit organization, we have more than 35 years’ experience improving healthcare across the continuum of care using evidence-based and data-driven logic. MPRO provides medical consulting and review, as well as data analysis to federal agencies, state Medicaid and public health organizations, healthcare facilities, private health plans and other third-party payers. We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews. Our goal is simple – to help healthcare get better!

This position can be remote and provides the opportunity to work virtually with team members from anywhere within the United States. We pride ourselves on providing a great work/life balance for employees, while also providing the ability to promote their career development and gain new skills through employee education opportunities. MPRO offers a wonderful benefit package that includes medical, dental, vision, life insurance, short term and long-term disability, and a generous 401k match.

MPRO is committed to improving the quality, safety, and efficiency of healthcare. Although we do not see patients, we are healthcare professionals (including physicians and nurses) and consultants who work with healthcare providers to promote the adoption and use of evidence-based best practices and processes to achieve our healthcare quality goals. Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of healthcare. It is our #1 priority to provide thoughtful evidence-based strategies and solutions that help them achieve their healthcare quality improvement goals and outcomes.

SUMMARY:

The Review Nurse works as part of a collaborative team to coordinate and complete assigned reviews and assists medical reviewers in assimilating detailed case review summaries. The Review Nurse evaluates all completed case summaries to ensure the report meets quality standards and includes appropriate evidence-based clinical guidelines and the American Correctional Association (ACA)/National Commission on Correctional Healthcare (NCCHC) standard references, as appropriate. Core Competencies include clinical acumen, accountability, collaboration, effective communication, accountability, effective time management and problem-solving skills.

DUTIES AND RESPONSIBILITIES:

  • Assist MPRO’s correctional review team with completing a variety of medical reviews including correctional untimely death cases.
  • Use relevant evidence-based clinical guidelines, nationally recognized protocols and ACA/NCCHC standards for all case summaries.
  • Develops and monitors timelines/workplans to ensure case review quality, completeness and timeliness.
  • Serve as clinical resource for review team and external customers.
  • Collect, assess, report and present contract performance data including (e.g., authorizations and metric compliance).
  • Actively identifies performance improvement opportunities and/or partakes in activities as requested, and modifies clinical practices based on CQI recommendations and metrics.
  • Adhere to all relevant Federal and State regulations (HIPAA, FISMA, CMS) and uphold rules governing medical confidentiality.
  • Maintains ethical commitment to ensure confidentiality within the limits of a correctional environment.
  • Completes other duties as assigned.

EDUCATION AND/OR EXPERIENCE:

  • Registered nurse with licensure in relevant state as appropriate
  • Bachelor’s Degree preferred
  • Experience working with a correctional institution or system required
  • Health Services Administrator experience a plus
  • Clinical experience required
  • Healthcare quality improvement a plus
  • Utilization management certification a plus
  • Company:
    Michigan Peer Review Organization
  • Job Type:
  • Posting Date:
    11th May 2022
  • Valid through:
    11th Jun 2022
  • Location:
For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. By applying to a job using RedHired you are agreeing to comply with and be subject to the RedHired Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.