Nurse Reviewer

Exempt Position Description – Nurse Reviewer

DEPARTMENT:     Claims – Medical Records

LOCATION:             Topeka

REPORTS TO:       Medical Records Manager

POSITION SUMMARY

The Nurse Reviewer position plays an important role in the KAMMCO Medical Records and Claims Departments. External Medical and Legal professionals, together with KAMMCO management teams and co-workers, depend heavily upon the Nurse Reviewer’s knowledge, experience and assistance.

The Nurse Reviewer’s primary responsibility is to prepare chronologies and detailed case analysis of medical records, as well as conduct medical research related to each case for the Claims Department located in Topeka and Wichita, KS.

DUTIES AND RESPONSIBILITIES

·        Works with medical records staff as needed to support individual records identification, collection, organization, electronic formatting and review processes.

·        Reviews the medical records in electronic format.

·        Uses Microsoft Word and prepares a detailed, incident-focused verbatim chronology of the medical records received according to a specific and consistent format

·        Prepares a detailed memo in Microsoft Word for the Medical Liability Analyst (MLA) and attorney, according to a specific and consistent format.

·        Uploads nursing documentation into OnBase.

·        Performs medical research as needed via the Internet and other resources to support case review and as requested by the MLA and/or attorney.

·        Identifies additional health care providers in the medical record that may need to be contacted for records collection.

·        Communicates with MLAs regularly regarding the status of case activity and litigation issues.

·        Participates and communicates with the Claims team, attorneys, paralegals, etc., as needed, orally and in email, regarding clinical review of the records.

·        Completes departmental, detailed electronic tracking database as needed to document case work.

·        Updates chronologies and memos as appropriate when medical records are received.

·        Assists with nurse reviewer and managerial administrative work as needed.

·        Prioritizes work load and coordinates record reviews with the MLA according to case deadlines and litigation activity.

·        Maintains complete confidentiality regarding all aspects of litigation and medical records information.

·        Supports the business goals of KAMMCO.

·        Performs other duties as assigned.

QUALIFICATIONS

·        Unrestricted license in the state of Kansas as an LPN or RN with at least 3 years' experience, required. 

·        Maintenance of current nursing licensure in the state of Kansas, required.

·        Ability to maintain confidentiality as appropriate and work in a confidential environment, required.

·        Excellent computer research and writing skills required.

·        Ability to work with minimum supervision and set own priorities required.

·        Strong communication skills including writing, speaking, listening, and reading required.

·        Prior medical legal experience strongly preferred.

·        Prior strong history of clinical and/or litigation case review experience preferred.

·        Ability to use independent judgment related to medical record review.

·        Proficient typing and excellent computer research skills.

·        Proficient computer skills (Microsoft Windows operating systems including Word, Excel, Outlook).

WORKING CONDITIONS

Professional office environment. Contact with medical office staff, member insureds, attorneys and the general public. May deal with angry or upset people. Multi-task position requiring strong attention to detail. 

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.