Registered Nurse - Case Review Specialist - *Position is Remote/Nationwide

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for STG International. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. STGi is currently seeking a Registered Nurse-Case Review Specialist . The position is remote and open to candidates nationwide. Job Summary Provides direct support to the mission of Federal Occupational Health (FOH), a component of the Program Support Center (PSC), to improve the health, safety, and productivity of the Federal workforce by performing fulfillment of case review activities (review of service and provider fulfillment), interacting with internal and external customers regarding questions and clarification of services or other communication essential to the maintenance of the agreement and coordinating service delivery with FOH Business Operations team. Serves as a Registered Nurse Case Review Specialist for the case review process to include ensuring exam scheduling, appropriate management and processing of all medical records, Quality Assurance (QA) checks are completed , and charges and administrative fees are entered to cost recover on all exams according to the Interagency Agreement (IAA). The Registered Nurse Case Review Specialist will ensure that complete exams are sent to the RMO for review in a timely manner via secure transmission. The Reviewing Medical Officer (RMO) determinations will be sent to the customer agency and their employees (as applicable) via secure transmission. Registered Nurse Case Review Specialists will apply critical thinking and sound nursing judgement when reviewing exam packets, retrieving missing exam items, entering in medical data into Merits, submitting the exam packets for RMO review, and when working through the determinations. The Registered Nurse Case Review Specialist will address examinee and customer concerns and be able to provide updates on pending cases. Other duties may include reach out to clinics to retrieve missing exam items, work with Occupational Health Clinics (OHC) to ensure all portions of exam completed are billed for appropriately, collaborate with FOH team members to ensure workflow facilitates the customer needs are met, relay any concerns raised by customers to Program Manager (PM). • Ensure exam scheduling requests are submitted timely , and appointment notifications are tracked in accordance with the designated timeframe . • Retrieve exams for case review processing (from the FOH clinics and the FOH Private Provider Network clinics). • Enter in tickets for services performed at the FOH Private Provider Network (PPN) clinics. • Process exams which include the QA of the exam, tracking any missing exam components, ensuring the exam is complete and has all components needed per the work order, and send the exam to the RMO for processing. • Track exams and ensure exam processing is fluid and timely . • Enter applicable data on RMO Timesheets. • Ensure medical reviews, letters, and exams are sent securely as applicable. • Enter tickets to charge the associated agency for the AMA/RMO time. • Participate in cost recovery efforts which will include verifying/validating, editing, and updating billing tickets as needed. • Professionally communicate with fellow team members, internal, and external customers. Exam Processing Quality and Safety • Ensure case review processing timeframes and quality assurance parameters are met as directed by the Program Manager (PM) before cases are forwarded to an RMO for review and/or to the agency. • Attend all mandatory meetings and trainings as assigned. • Demonstrate understanding of the Case Review process, work to learn new workflows and processes. • Display competencies in all areas of case review. Service Operations • Ensure scheduling requests are submitted within 24 hours of receipt to the appropriate OHC or through the Private Network Provider (PPN). • Ensure medical records are retrieved using the PPN portal daily and the internal electronic file storage. • Reach out to OHC clinic to request records after exam completion. Follow up on any missing exam items timely and track to ensure requested item has been received , is complete, and is entered in tracking system. • Ensure exams are processed timely to meet the requirements of FOH. Upon receiving a complete exam, QA, send to the RMO (if applicable), complete data entry/tracking, and send RMO determination to agency. • Escalate missing exam items to PM when items are not received . • Transmit exams according to IAA specifics and dates tracked. • Report all privacy and security breaches immediately according to FOH and HHS policy. • Attend all meetings with team and internal customers as directed. Administrative (Business/Management) Procurement • Coordinate with Business Operations team to provide customer services (e.g., exams, outreach, etc. ) through FOH OHCs and the PPN. • Assist with implementing new case review business and changing requirements for existing business when new agreements are initiated or if an existing agreement is modified . Cost Recovery • Ensure RMO and admin billing is completed , review any discrepancies, and notify PM. • Review PPN invoices each month, identify discrepancies, and correct billing as needed. • Ensure all billing items have been entered correctly and timely , concurrently when reviewing exams. • Demonstrate a complete understanding of the current database used for billing, RMO reviews and exam tracking. • Participate in rolling audits by analyzing reports, validating charges, and ensuring any missing charges are entered or discrepancies rectified timely . Staffing and Reporting Relationships • Be on time to work and work all designated hours as determined by PM. • Request leave according to specified timeframes with vendor and PM. • Adhere to telework policy when permitted . • Create a climate of trust, accountability, and professionalism. Report to PM staffing concerns which can affect productivity and morale. • Identify and report problems with hardware, telecommunications or other issues impacting duties to PM. Technology • Fully knowledgeable and proficient in IT systems , for database tracking, billing, and other deliverables, to include but not limited to Microsoft Word, Excel, Outlook, Teams and Adobe Acrobat. • Attends training on IT systems and completes mandatory IT training by specified deadlines. • Inform PM of IT and other equipment needs , particularly those that prevent completion of case review processing within specified deadlines. • Performs all FOH associated tasks on Government Furnished Equipment. Strategy Customer Service • Manage customer/agency complaints professionally with feedback within 24- 48 hours of receipt. If unable to resolve the complaint, communicate with customer this issue is being addressed and follow up as soon as possible, including PM. For urgent matters, notify PM immediately . • Ensure exam processing timeline is met per the agency agreement. • Communicate with RMO’s when a specific/urgent request is needed . Metrics • Generate customer specific reports as required per the agency agreement. • Input data into tracking sheets to retrieve metrics as requested by leadership. • Suggest process improvements to PM to ensure that quality and efficiency goals for the case review team are met . • Ensure data is entered completely for case review processing into database and onto agency specific trackers to include the exam scheduling tracker and exam tracker. Required Skills REQUIRED EXPERIENCE AND SKILLS: • RNs with at least 5 years of Nursing experience preferred. • One year of experience in occupational health or related experience such as public health/community health, outpatient clinic, school nursing or physician office nursing experience preferred. • Must appropriately escalate problems or resource issues for resolution. • Must possess s trong communication , relationship building and influencing skills ; both verbal and written. • Must have a can-do, positive attitude and build constructive working relationships. • Must demonstrate leadership, communication, and organizational skills along with the ability to problem solve . • Must be able to m ake effective presentations to achieve desired outcomes. • Must have h igh proficiency in Microsoft Office software including Outlook, Word, Excel and PowerPoint. • Must be highly organized and be able to manage competing priorities. • Must be able to assess tasks, prioritize, and work efficiently. • Must be able to work in fast paced production environment. Required Experience REQUIRED EDUCATION AND CERTIFICATION/LICENSURE : • Must possess full, active, current and unrestricted licensure as a licensed Registered Nurse in a State, Territory or Commonwealth of the United Sates, or the District of Columbia. • Must be a graduate of an accredited school of nursing. BSN degree is recommended, but not required . AA degree is acceptable. • Current CPR/AED for Health Care Professionals certification Working Conditions/Physical Requirements N/A DISCLAIMER The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification . It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. STGi is a workforce solutions company providing comprehensive healthcare delivery, Head Start and management consulting services and human capital solutions help our clients. Our services and solutions help our clients sustain and enhance their operations to better accomplish their mission. STGi offers a competitive benefits package which includes Medical, Dental, Vision, 401k with company match and a generous PTO policy. STGi is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. Medical Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse Corps - 66B,66H, 66P Medical Service Corps – 67G, 67J Medical CMF – 68A, 68B, 68E, 68F, 68G, 68J, 68Q, 68R, 68S, 68T, 68W, 68X, 68Y If you have questions about this posting, please contact [email protected] Apply tot his job