Clinical RN or LPN

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Conduct quality assurance evaluations of peer review reports, correspondences, addendums, and supplemental reviews.

• Ensure that all recommendations and determinations are supported by clear, concise, and evidence-based rationales.

• Confirm adherence to client instructions and specifications, addressing all inquiries appropriately.

• Verify that reviews are backed by up-to-date clinical citations and references from reputable medical journals or publications when relevant.

• Ensure that report content, formatting, and professional presentation align with company standards.

• Confirm that the appropriate board specialty reviews each case in accordance with client specifications or state mandates and that this is accurately documented.

• Identify any inconsistencies in reports and reach out to Peer Reviewers for clarification, modification, or correction.

• Address quality assurance inquiries and provide assistance to the Quality Assurance Department.

⛳️ Requirements

• Candidates must be an RN or LPN to be eligible for consideration.

• A background in healthcare quality, compliance, or utilization review is advantageous.

• Experience collaborating with peer reviewers or clinical consultants in a quality assurance or review role is preferred.

• Familiarity with ERISA and state regulatory requirements concerning clinical reviews and documentation is important.

• Excellent communication skills are necessary for interaction with reviewers, internal teams, and other stakeholders.

• Willingness to work in a contract-to-hire arrangement with the potential for long-term engagement is required.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital coverage.

• 401(k) Retirement Plan with options for pre-tax and Roth post-tax contributions.

• Life Insurance, including Voluntary Life & AD&D for employees and their dependents.

• Short- and long-term disability insurance.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Time Off/Leave options (PTO, Vacation, or Sick Leave).