Quality Management Nurse

COMPANY OVERVIEW: Physicians' Review Network (PRN) is a national Independent Medical Review Organization that provides expert, cost-effective and unbiased reviews to facilitate medical service decisions. Our mission is to promote quality patient care and medical integrity through expert physician review of medical necessity and appropriateness of services. PRN assists HMOs, TPAs, Insurance Companies, PPOs, Workers' Compensation Administrators, Self-funded Employers, and Government Entities. For more information, please visit our web site at www.prniro.com REQUIREMENTS: The Quality Management Nurse shall, at a minimum: hold a current, active, unrestricted nursing license, be oriented in the principles and procedures of utilization management, the American Accreditation HealthCare Commission URAC UM Standards, and peer review. JOB DESCRIPTION: The Quality Management Nurse shall carry out the following duties; Serve as clinical consultant to all non-clinical case processing staff, conduct ?Final QA? on reports when Associate Medical Directors not available; discuss cases with physician reviewers if necessary, monitor the accuracy and completeness of cases before they are sent out to physician advisors, provide input into the clinical review process and assist in the orientation, education and supervision of personnel involved with the review process. This position also requires interaction with clients. The quality management nurse is expected to serve as liaison with clients, case managers and others for the purpose building rapport and promoting an effective and efficient clinical review process. The Quality Management Nurse is expected to assist in resolving client complaints about clinical issues with reports.