Position Description: Quality Assurance Review Nurse

PRI has an immediate opening for a talented Quality Assurance Review Nurse. If you are interested in joining our team we welcome you to apply.

Reporting to the Program Manager, the QA Review Nurse will provide professional assessment, planning, coordination, implementation and reporting of complex clinical data and support the medical review operations of Provider Resources, Inc. (PRI). The nurse position will perform comprehensive medical record to make utilization, quality of care, and standards of care determinations based on evidence-based standards of care, applicable coverage policies, and utilization and practice guidelines.

Responsibilities

  • Understand and represent PRI?s mission, vision, and values to all internal and external customers
  • Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
  • Interact with government and private sector clients, partners, and PRI staff in a professional and accountable manner, and as a representative of PRI
  • Screen cases upon intake for referral to peer reviewers
  • Perform medical record review in accordance with all State, Federal and/or commercially mandated regulations
  • Performs QA for non-physician reviews and supports PM
  • Maintain compliance with all regulation changes as they impact medical and utilization review practices
  • Analyze patient records and participate in interdisciplinary collaboration with PRI staff and all recognized teaming partners and/or subcontractors
  • Document all review information into the appropriate Medical Review form, report and/or system. Communicate these report results to the appropriate supervisor
  • Utilize electronic health information imaging
  • Utilize Internet and Intranet resources for applicable research, e.g., evidence-based standards of care guidelines, quality measures, etc.
  • Make clinical judgments based on evidence-based standards of care, review criteria and nursing practice guidelines when applicable
  • Understand and represent PRI?s mission, vision, and values to all internal and external customers
  • Perform other duties as requested

  • Company:
    Provider Resources, Inc.
  • Job Type:
  • Posting Date:
    11th May 2022
  • Valid through:
    11th Jun 2022
  • Location:
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