... (RN), Physical Therapists (PT), Occupational Therapists (OT), and Respiratory Therapists (RT). This is a remote position that can be based anywhere in the United States. Must be able to work on a ...
New
... (RN), Physical Therapists (PT), Occupational Therapists (OT), and Respiratory Therapists (RT). This is a remote position that can be based anywhere in the United States. Must be able to work on a ...
New
... than remote. Work area has to be in a separate room in home with door that will remain closed ... Licenses: Active SC unrestricted RN licensure Certifications: N/A Shift Hours: Monday through ...
... than remote. Work area has to be in a separate room in home with door that will remain closed ... Licenses: Active SC unrestricted RN licensure Certifications: N/A Shift Hours: Monday through ...
Remote Cortex Rn information
What are the key skills and qualifications needed to thrive as a Remote Cortex RN, and why are they important?
To thrive as a Remote Cortex RN, you need a valid RN license, strong clinical judgment, and proficiency in remote patient monitoring and telehealth practices. Familiarity with telemedicine platforms, electronic health records (EHRs), and secure communication systems is crucial. Exceptional communication, critical thinking, and the ability to work independently are important soft skills in this role. These competencies ensure effective remote care, patient safety, and smooth collaboration with healthcare teams despite the physical distance.
What are some common challenges Remote Cortex RNs face while providing patient care from a distance?
Remote Cortex RNs often navigate challenges such as building trust with patients without face-to-face interaction, ensuring clear communication through digital platforms, and adapting clinical assessments to virtual formats. They must stay organized and proactive in following up on patient needs, as well as collaborate closely with physicians and interdisciplinary teams remotely. Staying updated on telehealth best practices and technology can help overcome these hurdles and ensure high-quality patient care.
What is the difference between Remote Cortex Rn vs Remote Medical Assistant?
| Aspect | Remote Cortex Rn | Remote Medical Assistant |
|---|---|---|
| Credentials | Registered Nurse (RN) license | Certified Medical Assistant (CMA) or similar certification |
| Work Environment | Telehealth, hospitals, clinics | Telehealth, clinics, outpatient settings |
| Job Responsibilities | Patient assessments, care planning, medication management | Scheduling, patient intake, basic clinical support |
| Industry Usage | Healthcare, telemedicine | Healthcare, outpatient services |
Remote Cortex Rn and Remote Medical Assistant roles both operate in healthcare settings, often remotely, but RNs require licensure and handle clinical patient care, while Medical Assistants focus on administrative and basic clinical tasks. Understanding these differences helps job seekers find roles aligned with their credentials and career goals.
What is a Remote Cortex RN?
A Remote Cortex RN is a registered nurse who works remotely to monitor and manage patient data using the Cortex platform or similar remote patient monitoring technologies. These nurses assess patient information, provide virtual consultations, and coordinate care from a distance, allowing for continuous patient support without the need for in-person visits. This role requires strong clinical knowledge, technological proficiency, and excellent communication skills to ensure high-quality patient care in a virtual environment.
What are popular job titles related to Remote Cortex Rn jobs in Lexington, SC? For Remote Cortex Rn jobs in Lexington, SC, the most frequently searched job titles are:
What job categories do people searching Remote Cortex Rn jobs in Lexington, SC look for? The top searched job categories for Remote Cortex Rn jobs in Lexington, SC are:
What cities near Lexington, SC are hiring for Remote Cortex Rn jobs? Cities near Lexington, SC with the most Remote Cortex Rn job openings:
Clinical Appeals Reviewer (Licensed Healthcare Professional)
St. George Tanaq CorporationColumbia, SC • Remote
Other
This job post has expired 1 day ago. Applications are no longer accepted.
Job description
Clinical Appeals Reviewer (Licensed Healthcare Professional)
Fully Remote•United States
Job Type
Full-time
Description
Overview
Tanaq Support Services (TSS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan Native Corporation (ANC) committed to serving Federal customers while also giving back to the Tanaq native community and shareholders.
About the Role
We are seeking a Clinical Appeals Reviewer to support a contract with our federal client. The Clinical Appeals Professional performs complex (senior-level) work. Provides dissatisfied parties with the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. Qualified candidates must be licensed health care professionals capable of rendering independent clinical judgment, including but not limited to Registered Nurses (RN), Physical Therapists (PT), Occupational Therapists (OT), and Respiratory Therapists (RT).
This is a remote position that can be based anywhere in the United States. Must be able to work on a rotating schedule on weekends and holidays.
Responsibilities
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Reviews medical records/case files, writes reconsideration decision letters that are clear, concise, and impartial, and support the determination made, and documents the review.
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Makes sound, independent decisions based on medical evidence in accordance with statutes, regulations, rulings, and policy.
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Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
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Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
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Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.
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Stays abreast of changes in regulations, medical and healthcare practices, policies, and procedures.
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Participates in case-specific verbal discussions.
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Conducts reviews of appeals/disputes with multiple beneficiaries/services in one case.
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Plans responses to statistical analysis challenges with assistance from statisticians.
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Attends meetings and participates in workgroups at management's direction.
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Conducts quality reviews, as needed.
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Serves as a subject matter expert.
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Mentors and/or trains staff.
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May conduct quality reviews and audits.
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Participates in special projects and performs other duties as assigned.
Requirements
Required Skills and Experience
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Three (3) years of experience in medical dispute resolution, Medicare appeals, medical review, clinical work, or related healthcare roles.
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Healthcare Professional with experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy experience.
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Demonstrated experience writing or making medical necessity decisions.
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Proficiency in research techniques, medical terminology, and analyzing and interpreting policies, along with knowledge of state and federal laws and regulations.
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Must have experience and working knowledge of the Medicare program, including coverage and payment rules.
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Experience with Medicare regulations, claims processing, and the medical review process, as well as applicable laws, rules, and regulations.
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Prioritize and organize work tasks to handle multitasking and meet deadlines.
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Ability to prepare correspondence and documents using correct spelling, grammar, and punctuation; proofreading and reviewing documents for clarity and consistency.
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Practice logic and reasoning to identify problems, verify facts, and reach valid conclusions.
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Experience in making decisions that support business objectives and goals.
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Ability to identify and resolve problems or refer issues appropriately.
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Communicate effectively verbally and in writing.
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Adapt to the needs of internal and external customers.
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Show integrity and ethical behavior, respect confidentiality, business ethics, and organizational standards.
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Ensure compliance with company policies, procedures, and guidelines, including cybersecurity, regulatory, contractual, and accreditation entities.
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Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred.
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Must have resided in the United States for a minimum of three (3) years out of the last five (5) years. This is a contractual requirement.
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Must possess a valid driver's license with a clear and satisfactory driving record.
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Ability to obtain and maintain public trust clearance and customer approval.
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Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.
Education and Training
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Associate's degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline.
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Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for an Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)
Physical Requirements and Work Environment
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Requires working in an office/cubicle environment; sitting, standing, walking, bending, twisting, and/or reaching.
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Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.
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May require the ability to operate a motor vehicle and travel by motor vehicle and commercial airline. May require overnight travel. Travel may be less than 5% annually.
Who We Are
Tanaq Support Services (TMS) is a public health contractor, certified 8(a) business, owned by St. George Tanaq Corporation, an Alaska Native Corporation. (ANC). We listen to our stakeholders and leverage our science, technology, communication, and program expertise to understand and provide feedback as we develop solutions.
Our Commitment to Non-Discrimination
Tanaq is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to disability, status as a protected veteran or any other status protected by applicable federal, state, or local law. Tanaq complies with the Drug-free Workplace Act of 1988 and E-Verify.
If you are an individual with a disability and need assistance completing any part of the application process, please email accommodation@tanaq.com to request a reasonable accommodation. This email is for accommodation requests only and cannot be used to inquire about the status of applications.
Notice on Candidate AI Usage
Tanaq is committed to ensuring a fair and competitive interview process for all candidates based on their experience, skills and education. To ensure the integrity of the interview process, the use of artificial intelligence (AI) tools to generate or assist with responses during phone, in person and virtual interviews is not allowed. However, candidates who require a reasonable accommodation that may involve AI are required to contact us prior to their interview at accommodation@tanaq.com.
To apply for this positions, visit:
https://recruiting.paylocity.com/Recruiting/Jobs/Details/4071254
About St. George Tanaq
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
1 - 10 Employees
Headquarters location
Anchorage, AK, US
Year founded
1973