Job Description

Are you passionate about  improving the quality of healthcare?

Are you ready to  leverage your talents to make healthcare better for everyone?

Do you want the opportunity to  give back to your community?

Do you want to have  fun at work ?

Then  join the growing team at Health Services Advisory Group (HSAG) that is transforming the delivery of healthcare in the United States!

Located in Honolulu, Hawaii, the Nurse Reviewer is responsible for coordinating and conducting various review activities as defined by HSAG’s contract with the State of Hawaii, Department of Human Services MedQUEST Division (DHS/MQD). Clinical review activities include long-term care level of care (LTC LOC) evaluations and determinations, Preadmission Screening and Resident Review (PASRR) compliance audits, and peer review of quality of care (QOC) concerns. The Nurse Reviewer is responsible for using professional judgement to apply the appropriate, established screening criteria. The reviewer is responsible for timely and accurate completion of all assigned review activities, including data entry into the Hawaii level of care (HILOC) and ePASRR electronic databases. The reviewer also works with HSAG’s medical director on level of care evaluations that do not meet established guidelines and assists with QOC reviews and report writing. The Nurse Reviewer is also responsible for assisting the production of the monthly, quarterly, and annual reporting of review activities.

• Independently conduct LTC LOC determinations and PASRR reviews within established DHS/MQD timelines; maintain 90 percent accuracy overall.
• Use appropriate, established screening criteria (State of Hawaii criteria for LOC decisions) to each LTC LOC determination; maintain 90 percent accuracy overall.
• Use critical thinking skills and professional judgement to identify potential utilization and QOC concerns; clearly communicate case referrals to DHS/MQD RN consultant.
• Communicate with Medicaid beneficiaries and applicants, physicians, administrators, and other professional staff on case review processes, case determinations, and report findings.
• Conduct training and educational seminars with educate providers and beneficiaries on Medicaid requirements as they relate to review/oversight activities; provide technical assistance to DHS/MQD, QUEST integrated health plans, and providers/facilities.
• Answer phone calls, feedback requests for assistance with HILOC application, ePASRR application, and clinical questions.
• Project deadlines may necessitate occasional extended work hours.

Compensation: $95,000 - $100,000 DOE

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