Remote Nurse Reviewer II - Hawaii

Job Details Are you passionate about improving the quality of healthcare? Are you ready to leverage your talents to make healthcare better for everyone? Do you want the opportunity to give back to your community? Do you want to have fun at work? Then join the growing team at Health Services Advisory Group (HSAG) that is transforming the delivery of healthcare in the United States! Summary Located in Honolulu, Hawaii, the Nurse Reviewer is responsible for coordinating and conducting various review activities as defined by HSAG's contract with the State of Hawaii, Department of Human Services MedQUEST Division (DHS/MQD). Clinical review activities include long-term care level of care (LTC LOC) evaluations and determinations, Preadmission Screening and Resident Review (PASRR) compliance audits, and peer review of quality of care (QOC) concerns. The Nurse Reviewer is responsible for using professional judgement to apply the appropriate, established screening criteria. The reviewer is responsible for timely and accurate completion of all assigned review activities, including data entry into the Hawaii level of care (HILOC) and ePASRR electronic databases. The reviewer also works with HSAG's medical director on level of care evaluations that do not meet established guidelines and assists with QOC reviews and report writing. The Nurse Reviewer is also responsible for assisting the production of the monthly, quarterly, and annual reporting of review activities. Essential Competencies, Duties and Responsibilities * Independently conduct LTC LOC determinations and PASRR reviews within established DHS/MQD timelines; maintain 90 percent accuracy overall. * Use appropriate, established screening criteria (State of Hawaii criteria for LOC decisions) to each LTC LOC determination; maintain 90 percent accuracy overall. * Use critical thinking skills and professional judgement to identify potential utilization and QOC concerns; clearly communicate case referrals to DHS/MQD RN consultant. * Communicate with Medicaid beneficiaries and applicants, physicians, administrators, and other professional staff on case review processes, case determinations, and report findings. * Conduct training and educational seminars with educate providers and beneficiaries on Medicaid requirements as they relate to review/oversight activities; provide technical assistance to DHS/MQD, QUEST integrated health plans, and providers/facilities. * Answer phone calls, feedback requests for assistance with HILOC application, ePASRR application, and clinical questions. * Project deadlines may necessitate occasional extended work hours. Compensation: $95,000 - $100,000 DOE Job Requirements: Education and/or Experience * Bachelor's degree in nursing is required. * Must hold an active, unencumbered RN license in the State of Hawaii. * Must have at least three years of clinical nursing experience. Acute care and/or long-term care experience preferred. * Knowledge of the Hawaii health care delivery system and Medicaid programs is preferred. Other Qualifications * Ability to maintain productive, professional, and effective relationships with internal and external clients. * Ability to correlate detailed medical information with approved criteria and/or standards of care. * Ability to read handwritten and electronic medical records. * Ability to be flexible in adjusting work hours to workload to assure reviews are completed within required timeframes. * Ability to appropriately communicate and problem solve with health care providers, Medicaid beneficiaries/applicants, and other professional staff. * Ability to communicate, pApply here:

Created: 2024-11-02