Nurse Reviewer

ECS was formed in 2014 from the acquisition and consolidation of two pillars within the Medicare Secondary Payer (MSP) compliance industry: Gould & Lamb, providers of MSP compliance and reporting services, and MedAllocators/Ability Services Network, a national provider of MSP compliance and case management. Launched as Examworks Clinical Solutions, the new company offered unprecedented, integrated services aimed at managing high dollar complex Medicare, medical, and pharmaceutical claims. In May 2020, the organization name was changed to ExamWorks Compliance Solutions. A single word change, but one that truly reflects the core of what is offered by ECS. Today, our mission remains focused on providing the most comprehensive, creative, and customizable compliance and reporting solutions for the marketplace.

If you are an RN who is interested in contributing to a dynamic, values-oriented workplace, you'll fit right in as a Nurse Reviewer with ExamWorks Compliance Solutions (ECS). The Nurse Reviewer works autonomously to review claims and develop any and/or all of the following: Life Care Plans, Medical Cost Projections, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews and other reports as needed within their scope of licensing and certifications. This is a full-time, 100% remote position with a schedule of Monday-Friday, 8:30am - 5:00pm EST.

Collects, reviews and analyzes health data from medical records and/or other sources as provided. Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care. Works autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed. Maintain a quality work product evidenced by acceptable quality scores/score cards. Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company. Attend all scheduled conference calls as mandated by management. Maintain any required credentials and adhere to all codes of ethics required by these credentials. Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times. Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform professional duties as assigned by the Manager or upper management.