Review Nurse

JOB TITLE: DIVISION: REPORTS TO:

Review Nurse Clinical Services Communication Liaison

COMPANY:

We are people who care about people. Our company has a unique history and was founded by two grandchildren of a former Department of Energy worker. Their love and determination for their grandfather to have the best quality care for the best quality of life is what drives our company to provide care for the energy worker population.

POSITION SUMMARY:
As the Review Nurse, you are responsible for evaluating for medical necessity and document quality that will assist clients to gain access to necessary medical, social, educational, and other services related to their accepted condition(s). The Review Nurse ensures adherence to established clinical policies, protocols, regulations, and standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Collaborate with the health care team to ensure the appropriate level of care if requested to ensure optimal patient care.
• Review all home healthcare requests for quality and medical necessity.
• Maintain departmental policies, procedures, objectives, or patient care standards, based on evidence-based practice guidelines or expert opinion.
• Stay current on nursing industry protocols.
• Implement and evaluate standards of nursing practice in specialty areas, such as oncology, pulmonary, and geriatrics.
• Maintain departmental policies, procedures, objectives, and infection control standards.
• Make clinical recommendations to physicians, other health care providers, insurance companies, patients, or health care organizations.
• Assist in the development of treatment plans and making recommendations to treating physician based upon patient assessment and nursing documentation.
• Plan, evaluate, or modify treatment programs, based on information gathered by observing and interviewing patients or by analyzing patient records.
• Monitor or evaluate medical conditions of patients in collaboration with other health care professionals.
• Participate in clinical research projects, such as reviewing protocols and patient records, monitoring compliance, and meeting with regulatory authorities.
• Participate in patient education programs that include information required to make informed health care and treatment decisions.
• Prepare reports to document patients' care activities.
• Write nursing orders.
• Conduct training of new review nurses.
• Maintain confidentiality of all office and client records per HIPAA and Privacy Act regulations.
• Performs other duties as assigned.

OTHER DUTIES AND RESPONSIBILITIES:

This position may require occasional traveling between locations in your personal vehicle

SUPERVISORY RESPONSIBILITY:

This position has no supervisory responsibilities.

PREFERRED QUALIFICATIONS:

• Active Registered Nurse license in the states that services will be provided. (Bachelor’s degree preferred)
• Minimum 2 years’ experience in geriatrics, medical, oncology, pulmonology, or equivalent field
• Experience working in the home health care industry or familiarity with home health care patients
• Knowledge of relevant regulations and guidelines, such as HIPAA
• Strong attention to detail
• Excellent written and verbal communication skills
• Ability to work independently and as part of a team
• Excellent organizational and time management skills to meet deadlines and handle multiple tasks simultaneously
• Proficient in Microsoft Suite
• Must pass a criminal background check and drug screen

WORK ENVIRONMENT and PHYSICAL REQUIREMENTS:

• Ability to sit at a computer terminal for an extended period of time.
• While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone, keyboard, reach, stoop and kneel.
• Specific vision abilities required by this job include close vision requirements due to computer work.
• Regular, predictable attendance is required as business demands dictate.