Registered Nurse – Case Review Specialist Position is Remote​/Nationwide

STGi is currently seeking a Registered Nurse-Case Review Specialist. The position is remote and open to candidates nationwide.

JOB SUMMARY:

Provides direct support to the mission of Federal Occupational Health (FOH), a component of the Program Support Center (PSC), to improve the health, safety, and productivity of the Federal workforce by performing fulfillment of case review activities (review of service and provider fulfillment), interacting with internal and external customers regarding questions and clarification of services or other communication essential to the maintenance of the agreement and coordinating service delivery with FOH Business Operations team.

Serves as a Registered Nurse Case Review Specialist for the case review process to include ensuring exam scheduling, appropriate management and processing of all medical records, Quality Assurance (QA) checks are completed, and charges and administrative fees are entered to cost recover on all exams according to the Interagency Agreement (IAA). The Registered Nurse Case Review Specialist will ensure that complete exams are sent to the RMO for review in a timely manner via secure transmission.

The Reviewing Medical Officer (RMO) determinations will be sent to the customer agency and their employees (as applicable) via secure transmission. Registered Nurse Case Review Specialists will apply critical thinking and sound nursing judgement when reviewing exam packets, retrieving missing exam items, entering in medical data into Merits, submitting the exam packets for RMO review, and when working through the determinations.

The Registered Nurse Case Review Specialist will address examinee and customer concerns and be able to provide updates on pending cases.

Other duties may include reach out to clinics to retrieve missing exam items, work with Occupational Health Clinics (OHC) to ensure all portions of exam completed are billed for appropriately, collaborate with FOH team members to ensure workflow facilitates the customer needs are met, relay any concerns raised by customers to Program Manager (PM).

• Ensure exam scheduling requests are submitted timely, and appointment notifications are tracked in accordance with the designated timeframe.
• Retrieve exams for case review processing (from the FOH clinics and the FOH Private Provider Network clinics).
• Enter in tickets for services performed at the FOH Private Provider Network (PPN) clinics.
• Process exams which include the QA of the exam, tracking any missing exam components, ensuring the exam is complete and has all components needed per the work order, and send the exam to the RMO for processing.
• Track exams and ensure exam processing is fluid and timely.
• Enter applicable data on RMO Timesheets.
• Ensure medical reviews, letters, and exams are sent securely as applicable.
• Enter tickets to charge the associated agency for the AMA/RMO time.
• Participate in cost recovery efforts which will include verifying/validating, editing, and updating billing tickets as needed.
• Professionally communicate with fellow team members, internal, and external customers.

• Ensure case review processing time frames and quality assurance parameters are met as directed by the Program Manager (PM) before cases are forwarded to an RMO for review and/or to the agency.
• Attend all mandatory meetings and trainings as assigned.
• Demonstrate understanding of the Case Review process, work to learn new workflows and processes.
• Display competencies in all areas of case review.

• Ensure scheduling requests are submitted within 24 hours of receipt to the appropriate OHC or through the Private Network Provider (PPN).
• Ensure medical records are retrieved using the PPN portal daily and the internal electronic file storage.
• Reach out to OHC clinic to request records after exam completion. Follow up on any missing exam items timely and track to ensure requested item has been received, is complete, and is entered in tracking system.
• Ensure exams are processed timely to meet the requirements of FOH. Upon receiving a complete exam, QA, send to the RMO (if applicable), complete data entry/tracking, and send RMO…