Registered Nurse, Reviewer

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

📋 Description

• Analyze medical records thoroughly

• Prepare cases for review by physicians

• Conduct desktop reviews and audit tasks without physician involvement

• Efficiently and accurately abstract data and information related to reviews using the appropriate tools

• Assist and communicate with physician reviewers by summarizing case details and highlighting issues that need their expertise

• Execute mandatory case reviews and quality assurance tasks as required by contracts

• Ensure timely and precise adherence to the review process

• Achieve production targets consistently

• Generate reports and documentation while adhering to Medicare FFS and Medicare Advantage plan regulations

⛳️ Requirements

• Graduation from a recognized nursing school

• Valid professional nursing license

• At least 2–4 years of clinical decision-making experience with Medicare patients

• A dedicated home office setup and dependable internet access for secure viewing of protected health information

• Basic knowledge of PC-based computer systems

• Intermediate proficiency in various MS Office applications and a willingness to learn new software

• Only U.S. citizens and permanent residents will be considered for this position

• Experience in processing Medicare Appeals and familiarity with BFCC Medicare Quality Improvement Organization (QIO) core functions is preferred

• A degree in healthcare-related fields and a professional clinical background, especially with Medicare QIO experience, may also be considered

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance; employee premiums for the base plan are fully covered by the company

• Company-paid life and disability insurance, including short-term and long-term disability coverage

• Access to an Employee Assistance Plan and employee discounts

• 11 federal holidays observed

• Accumulation of Paid Time Off (PTO) with the option to carry over

• 401(k) retirement plan with company matching contributions

• Flexible Spending Accounts available for medical, dependent care, and transit expenses

• Tuition reimbursement and training support offered