This role focuses on telework-based clinical record review for medical necessity and case assessment, with a Nurse Practitioner evaluating charts and answering client-specific clinical questions. The work is advisory-only and centers on producing clinical summaries rather than direct patient care. The role also includes reviewing a range of case types within a structured workflow, with support for records organization, peer-to-peer coordination, and training.
Key Responsibilities
- Conduct thorough reviews of medical records and clinical cases.
- Provide clinical summaries and advisory opinions based on chart review.
- Answer specific clinical questions submitted by clients.
- Review case materials within a user-friendly work portal and organized record set.
- Participate in peer-to-peer calls when adverse determinations require additional review.
- Use provided treatment guidelines and chronological medical record summaries to support determinations.
- Coordinate case completion within required turnaround times.
Required
- Certification as a Nurse Practitioner.
- Active Indiana Nurse Practitioner license.
Preferred
- Experience with medical record review or utilization review.
- Familiarity with advisory-only, non-patient-facing clinical work.
Benefits & Perks
- Telework arrangement.
- 1099 independent contractor status.
- Schedule flexibility and ability to choose services, case types, and volume based on availability.
- Streamlined case flow with administrative support.
- User-friendly work portal and click-to-view record and guideline format.
- Initial training and ongoing support contact.
- Peer coordinators who help secure provider availability for peer-to-peer calls.