Clinical Claim Review RN - Medical Disability - Remote

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Navigate and work within our proprietary electronic medical record system to evaluate and process patient health information to determine outcomes for various types of medical and specialty exams. Conduct a clinical review of a variety of examination documentation, test results, assessments and information and, by corroborating via phone interview with Service Members and Veterans, provide a clear, comprehensive and concise final product. Utilize clinical judgement to identify quality assurance issues and make recommendations to reconcile documentation. Collaborate with providers, Veterans, and Service Members via the nurse call line to ensure examination meets regulatory and contractual requirements for compensation and benefit rating purposes. Possess the ability to shift focus and multitask while maintaining professional demeanor to meet customer and provider needs. Identify emergent behavioral health issues and initiate intervention when necessary.

Remain up to date with the contract requirements Use clinical judgement to ensure a clear, comprehensive and concise exam documentation that is reflective of the patient’s service level conditions and in compliance to contract requirements Interpret and document diagnostic test results Educate and support providers, Veterans, and Service Members with navigating and utilizing medical history information and prior disability claims when completing the appointment paperwork Answer calls that come into the Clinical Operations Review queue in regards to medical or specialty exams, and provide exemplary service to providers with appointment questions Identify and evaluate exam documentation that requires immediate follow up for behavioral health issues and initiate the high risk intervention process Complete system generated tasks to process exam documentation Interface via telephone (up to 75%) and e-mail with contracted providers, Veterans, and Service Members in retrieval of required Disability Benefits Questionnaire information and provide education regarding required contractual protocol