Clinical Nurse Reviewer

March 28, 2024
Application ends: April 30, 2024
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Job Description

CHCS is a company positioned for growth and excellence. It may not be an exciting time in the marketplace, so we aim to shake things up. We are looking at acquiring more companies and we have already begun to place a larger investment in technologies and tools for our associates and our customers.Our storyWe’ve been in business for over 30 years. We are a global company with delivery centers in the USA and INDIA. CHCS is an award-winning insurance third-party administrator (TPA) of senior health products. We are in the business of providing state-of-the-art administrative support services and customized care solutions to manage policies and claims. CHCS Supports some of the largest senior market insurance companies in the world. Processing hundreds of thousands of claims every year and our vast network of experienced registered nurses and healthcare professionals provide personalized care management services to policyholders.The futureWithin the next 5 years we are seeking to become THE leader in the TPA services marketplace! To achieve this goal, we know we’ll need to build an even stronger team. We are ready to invest in the company and in you.Investment in technologies: new call center technology is Five9s, and continually refresh of systems.Job Summary:

The Assessment Team Clinical Nurse Reviewer is responsible for the timely and accurate review of completed cognitive and functional assessments conducted for Long-Term Care Insurance policyholders. Assessments included are on-site, video, telephonic recertification and telephonic for private caregivers. Interacting with assessors, the Clinical Nurse Reviewer obtains necessary clarifications to documentation submitted, provide training to assessors who are new or need retraining on completing assessments and conducts telephonic assessments with other health care providers when an assessment/reassessment is needed for a claimant residing in a long-term care facility. The Clinical Nurse Reviewer reviews clinical questions from long term care insurers. The Clinical Nurse Reviewer documents and provides input on the quality of assessors upon completing their review.

Essential Job FunctionsReviewing completed assessment documents

  • Following up with nurse assessors to correct or clarify results where needed.Providing training for nurse assessors to ensure a quality assessment is performed.Completing telephonic assessments of claimants and caregivers when necessary.The essential job functions listed above are not all encompassing. Other duties and responsibilities may be required.
  • Performance Expectations:
  • Communicate with both internal and external resources with professionalism.Complete assessments reviews in a timely manner ensuring accurate information in each assessment before submission to Long Term Care Insurance companies.
  • Required Skills/Abilities:
  • Show initiative and good nursing judgment.Typing skills 45 wpmKnowledge of Windows, Microsoft Suite and Adobe EditorExhibit excellent customer service skills.Work on multiple tasks at any one time while maintaining high quality standards.Must be process-oriented with sound judgement, attention to detail, accuracy, and follow-through including the flexibility to perform in an ever-changing work environment.Must have hi speed internet of at least 80 mbps per minute.Enclosed room within your home, for a quiet and HIPAA compliant work environment.
  • Required Education and Experience:
  • High school diploma or GEDAn unencumbered Registered Nurse in the state of residence. Verification of certificate from an approved school of Nursing.Six months to one-year previous related experience in a healthcare environment specifically working with elderly, geriatrics, memory care community or the like preferred.Alzheimer’s certification, clinical case management and/or assisted living experience preferred.
  • Physical Requirements:
  • Prolonged periods of sitting at a desk and working on a computer.