Job description

Oncology Nurse Reviewer

RTR Financial Services has been in business since 1999 collecting on behalf of hospitals from insurance carriers. If debt settlement agencies were not in business, patients would be held responsible when an insurance carrier has failed to pay. In recent years, RTR has expanded its services to include government collections, such as parking and camera violations. As we continue to grow, we are serving more hospitals nationwide and other forms of debt settlement collections.

Full Job Description

Appeals of accounts for which reimbursement was denied on utilization grounds by the insurer are prepared by a registered nurse. A registered nurse will thoroughly review a patient’s medical record to write an appeal that presents the clinical rationale for the patient’s hospitalization utilizing the Milliman Guidelines which RTR will provide for you. The appeal will focus on the dates for which reimbursement was denied, detailing pertinent information to substantiate that the services rendered were medically necessary and appropriately provided.

Summary of Position

· Investigate all clinical quality of care complaints/grievances received by the insurance carrier

· Conduct comprehensive clinical reviews of clinical quality of care complaints/or grievances received by the insurance carrier

· Research current standards of care which align with the clinical issue(s) identified in the investigation.

· Provide conclusive verbal and written clinical finding report(s) to the Quality Medical Director at weekly Clinical

· Formulate written responses, of the clinical quality of care investigation findings/conclusion(s) and provides

· Familiar process of a doctor’s visit. Directing chemotherapy and radiation services, authorization for services, and protocols for delivery and monitoring of said services.

Training

· Sample letters will be provided and thorough training as well on how to write an appeal to be above the standards in the industry.

· The training and this position can be done remotely. All documentation will be available through your computer.

Required Qualifications

• Bachelor’s Degree
• LPN or RN with current active, unrestricted license

Relevant Work Experience, Knowledge, Skills, and Abilities

• 3 – 5+ years of related professional experience.
• 3 – 5+ years of clinical experience in critical care, med-surgical or managed care.
• Quality Risk or Grievance and Appeal work history.
• Knowledge of accreditation and regulatory standards.
• Proficiency reading and interpreting medical records.
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.).
• Effective communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience.
• Ability to apply clinical criteria and guidelines

Compensation based on experience ($50-$125/per appeal)

Remote position

Job Type: Part-time

Pay: $50.00 - $125.00 per hour

Medical specialties:

• Oncology

Weekly schedule:

• Self-determined schedule

Experience:

• Microsoft Word: 3 years (Required)
• Oncology: 3 years (Required)

License/Certification:

• RN License (Required)
• ACLS Certification (Preferred)
• BLS Certification (Preferred)

Work Location: Remote

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