Nurse Reviewer

2 weeks ago

Oak Ridge, United States Zenith American Full time
Job DescriptionJob Description

Title: Nurse Reviewer Department: Govt Services

Bargaining Unit: NBU Grade: N/A

Position Type: Non-Exempt Hours per Week: 40


Position Summary:

Performs chart review of medical exams to determine medical necessity and appropriateness, in accordance with Company guidelines, client needs, and legislative requirements.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."


Key Responsibilities:

Chart Reviews

  • Reviews test authorized to assure testing was complete. Reviews medical test reports (labs, chest x- ray, b-read, audio, etc.), medical history, physical examination findings, and work history exposures.
  • Compiles summary letter for physician review/ signature or reviews summary letter provided by physician for accuracy and completeness. If a re screen exam also compares to prior results and addresses changes in summary letter.
  • Data enters diagnosis, PFT's, x ray, audio results into DMS. Selects/ marks appropriate educational material. Marks Provider Payment Screen authorizing payment to clinic/ providers.
  • Assembles chart for mailing, verifying results belong to worker, adding educational material and compensation information. Passes chart off to Admin Assistant for completion of mailing/ scanning

Phone calls

  • Provide phone coverage
  • Respond to inquiries regarding medical results

Labs

  • Back up for review of daily labs and notification to workers/ providers for abnormal findings.

Back up for QA of scanned chart and mail packet

  • Reviews scanned file of completed chart to assure all results belong to worker prior to mailing to patient
  • Reviews physical packet/ results to assure all results belong to worker and addressed correctly and seals envelope once QA is complete.

Minimum Qualifications:

  • Registered Nurse RN License.
  • Should have 5 or more years' experience as RN working in clinical setting
  • Possess a strong work ethic and team player mentality.
  • Highly developed sense of integrity and commitment to customer satisfaction.
  • Ability to communicate clearly and professionally, both verbally and in writing.
  • Ability to function independently within established guidelines.
  • Solid organization skills with strong detail orientation and listening skills.
  • Strong decision making, research and analytical abilities.
  • Ability to type 35 WPM; proficient PC skills, including MS Word and Excel.


Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently seeking an experienced Nurse Reviewer with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 40 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before

We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more


Internals to Apply:

If you meet the minimum qualifications and are interested in applying for the above position, please submit an application. All applications must be received by 5:00 pm on the Internal Posting Deadline listed above in order to be considered prior



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