Nurse Reviewer

  • location: Rockville, MD
  • type: Permanent
  • salary: $52,000 - $624,000 per year

job description

Nurse Reviewer

A Reputable Nurse Review Company withing the Montgomery County, Maryland Area is currently seeking Referral Management Nurse/Reviewer to assist with a Government client need. They are seeking a Nurse Reviewer to assist in the case managment and crednetialling processes invovled within their organizaition. Click to apply!

Responsibilities

• Provide Referral Management (RM) activities such as a timely review of Right of First Refusal (ROFR) requests, screening of specialty care referrals, sustaining up- to- date Specialty Clinic Referral and Booking Guidance, comply with Referral and Authorization Business rules, tracking and resulting in referrals, and full use of RM information management systems and

• Comply with Referral and Authorization Business rules, tracking and resulting of referrals, and full use of RM information management systems

• Conduct reviews for capacity and capability, and right of first refusal activities

• Reviews referrals for administrative, clinical completeness and appropriateness. Validates requested medical service, and authorizes surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations. Collaborates with DHA Regional Office Clinical Liaison Nurse and MTF Liaison to address any process issues or concerns.



Skills

  • credentialling
Education
  • Associates
Qualifications
  • Years of experience: 5 years
  • Experience level:Experienced
Shift: First

Working hours: 8 AM - 4 PM

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