Health Services - Nurse, Clinical Medical Review

Health Services - Nurse, Clinical Medical Review

This is a hybrid role where the main location is Canton. General Information Job Description: PURPOSE: The Clinical Medical Review Nurse handles day to day review activities for clinical medical review.

The Clinical Medical Review Nurse is responsible for managing and overseeing the clinical medical review process, ensuring compliance with regulatory standards and internal policies. This role involves working closely with various departments to ensure the quality and accuracy of medical reviews.

Key Responsibilities:

• Conduct comprehensive reviews of medical records to ensure accuracy and compliance with clinical guidelines.
• Collaborate with healthcare providers to clarify and resolve any discrepancies in medical documentation.
• Maintain up-to-date knowledge of clinical guidelines and regulatory requirements related to medical review.
• Provide training and support to staff on clinical review processes and best practices.
• Participate in quality improvement initiatives to enhance the clinical review process.

Qualifications:

• Registered Nurse (RN) license required.
• Bachelor’s degree in Nursing or related field preferred.
• Minimum of two years of experience in a clinical setting.
• Strong understanding of clinical guidelines and regulatory requirements.
• Excellent communication and interpersonal skills.

Location: Canton