POSITION SUMMARY:

• Review all curated patient data reports received for accuracy of clinical and demographic information; Review output of clinical care algorithms for accuracy and appropriateness in the context of each patients’ medical history, care plan goals, and medications.
• Based on patient medical history and health status, develop care plans for the treating providers to implement
• Review progress to care plans; identify patients at risk for a decline in health without greater adherence to care plans
• Support Data Quality Reviewers, LPN Reviewers and RN Reviewers in building their clinical knowledge and clinical decision making to enhance the quality of the initial reviews  
• Coach APP new hires to help them in building their understanding of the role, tools, and technology
• As needed, support initial clinical and demographic data review generated by the system to prepare and finalize final care plan sign off and billing.
• Identify discrepancies in data and/or algorithm output; escalate through defined channels for correction.
• Identify potential gaps in care to complete the review.
• Communicate with Director of Clinical Review on issues regarding quality, system capacity, and resource requirements, facility and/ or provider feedback.
• Meet established standards for productivity, quality, timeliness, and customer satisfaction 
• Performs all duties and responsibilities and adheres to the Nurse Practice Act. 
• Protects patient information and adheres to standard of confidentiality with all patient information
• All other duties as assigned.

MINIMUM REQUIREMENTS

• Advanced Practice Nurse Practitioner (Adult or Family) education and certification.
• Licensed as an Nurse Practitioner in at least 5 states
• Active and non-restricted license
• Knowledge and Skill in chronic care management and remote patient monitoring management preferred.
• Proficient with Adobe, Microsoft Word, Excel, and video conferencing platforms and Dashboard type platforms.
• Strong verbal/written communication and presentation skills
• Experience in working with team members to promote ideas, issues, and initiatives within a constructive group framework
• Must always represent the organization in a positive and professional manner
• Ability to organize and prioritize tasks
• Ability to work independently, be attentive to detail and maintain a positive attitude.