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Registered Nurse - Quality Assurance Case Manager

The CSI Companies Boonton, NJ Full-Time
$88,488.00 (Careerbuilder est.) What is the Careerbuilder Estimated Salary? Only about 20% of the jobs in our search results contain salary information. When a job posting doesn’t include a salary, we estimate it by looking at similar jobs in the same industry in that location. It is not necessarily endorsed by the employer and actual compensation may vary based on your experience.
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The CSI Companies is currently seeking a Nurse Reviewer to support one of our healthcare clients in the Mid/Northern NJ area. This is a REMOTE opportunity but must live in one of the following counties; Bergen, Passaic, Hudson, Union, Morris or Essex.  This role is responsible for performing clinical reviews and quality assurance of medical information. CSIORL

Hours: Monday – Friday, business hours

Pay Rate: $35-$41.61 per hour

Duration: Contract to perm 

Main Duties & Responsibilities:

  • Performs clinical and medical reviews, data collection and database entry
  • Assigns case reviews by identifying the issues for review and the specialty of the physician reviewer necessary to complete the peer matched review
  • Provides supporting reference documentation to the reviewer
  • Applies state laws during the Quality Assurance process
  • Apply Department of Health Registry data definition in data auditing
  • Assures that all work is completed within contractual deadlines and that all components of the completed review are present
  • Delivers final product to the client per client specific contractual guidelines
  • Communicates with appropriate parties the results of the audit
  • Utilizes clinical expertise and data definition to identify data discrepancies
  • Evaluates, identifies, and reports on, quality of care issues
  • Communicates with health care professionals as a liaison regarding contract specifications and escalates issues as appropriate
  • Participates in the project data analysis, reporting, and feedback processes
  • Performs other functions as assigned -(transition to other contract within the company at the end of Cardiac audits as business requires) 

Knowledge, Skills and Abilities:

  • Ability to work proficiently with Microsoft Word, Excel, and Power Point
  • Ability to analyze and evaluate medical information
  • Ability to provide good customer service skills
  • Ability to medically review; chart audits, and quality improvement processes
  • Ability to perform well in team environment, with staff at all levels, to achieve business goals
  • Ability to function under pressure and with deadline-oriented project demands as well as manage multiple initiatives
  • Ability to apply existing knowledge of health care marketplace including commercial and government insurance health plan organizations and HIPAA guidelines with their associated security requirements
  • Ability to work independently to meet predefined production and quality standards
  • Working knowledge in and successful application of basic level of health care data analysis and clinical review.

Required Education/Experience:

  • Unrestricted New Jersey RN license required
  • Associate’s degree or diploma (Nursing program) required
  • 3+ years clinical experience required, including at least 1 year of clinical experience in either ICU/CCU, Telemetry, Cath lab, OR, and ER
  • 1+ year utilization review experience preferred/or cardiac data extraction 

 

Recommended skills

Data Analysis
Data Definition Language
Data Extraction
Intensive Care Unit
Reports
Utilization Management

Location

CareerBuilder Estimated Salary What is the Careerbuilder Estimated Salary? Only about 20% of the jobs in our search results contain salary information. When a job posting doesn’t include a salary, we estimate it by looking at similar jobs in the same industry in that location. It is not necessarily endorsed by the employer and actual compensation may vary based on your experience.

x

What is the Careerbuilder Estimated Salary?

Only about 20% of the jobs in our search results contain salary information. When a job posting doesn’t include a salary, we estimate it by looking at similar jobs in the same industry in that location. It is not necessarily endorsed by the employer and actual compensation may vary based on your experience.
This estimation is based on Job title, Industry, Location and Skills
$88,488
Avg. Yearly Salary
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Job ID: 48251

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