Nurse Auditor/Peer Review Job in Irvine, California Us
- May assist in the assigning process of reviews to appropriate reviewers.
- Verify the reviewer addressed and responded to requesting nurse’s original request.
- Verify that the nurse’s request correlates to original doctor’s notes, prescriptions, and insurer’s referral. Communicate with requesting nurse to clear up any discrepancies.
- Check and correct grammar, spelling, syntax of reviews.
- Ensure correct date of injury and that date of review corresponds with date review is completed and sent.
- Ensure that terms used in review conform to jurisdictional and/or customer preferences as appropriate.
- Verify that review was done by correct provider (by degree, specialty) and ensure that name of reviewer, specialty, license number and state of licensure are indicated and correct on review.
- Make sure that any applicable state rules and guidelines have been addressed.
- Verify that all reviewed data is listed in review. May require communication with reviewing doctor.
- Verify conformity of recommendation to medical rationale. Rewrite rationale language if sufficient information is present in review. Apply guidelines/references to selected peer reviews as directed by Medical Director.
- Ensure appropriate disclaimer information is included.
- Maintains daily production standard of audits completed (dependent on daily work volume)
- Perform QI audit on technical writers and peer reviewers as designated by RN Supervisor.
- Contact peer reviewers via phone or email for re-training and document in the Intranet Reviewer Directory under the training section.
Ideal candidates will meet the following requirements:
- 3 or more years of experience in managed care/clinical care/peer review
- Experience in worker's comp is a plus
- Current CA RN license
- Excellent verbal and written communication skills
- Ability to write peer reviews as a technical writer
- Ability to work in a team setting within a fast paced environment
January 26, 2010
• Tags: California Us, Nurse Auditor, Peer Review Job in Irvine • Posted in: General