Virtual RN (Remote) — Pre-Visit Planning, Chart Review, Quality Care Gaps (CQV), CPT II Coding & Prior Authorizations

We’re hiring a detail-oriented Virtual Registered Nurse (RN) to support an internal medicine primary care practice with pre-visit planning, chart review, clinical quality validation (CQV), CPT II coding for care gaps, and prior authorizations. This role is focused on strengthening documentation, improving quality measure capture, and reducing administrative burden on the clinical team—while maintaining excellent standards for accuracy and HIPAA compliance.

Key Responsibilities
1) Pre-Visit Planning & Chart Review

Perform comprehensive chart review before scheduled visits (new + established patients).

Build pre-visit documentation and structured summaries for the provider/team, including:

Relevant history, active problems, and recent specialist updates

Recent labs/imaging and what’s due next

Preventive care needs and chronic disease monitoring opportunities

Flag missing documentation items that impact visit efficiency or quality capture.

2) Clinical Quality Validation (CQV) + Care Gap Support

Perform clinical quality validation (CQV) using payer quality portals/websites (as applicable) to confir ---------- asure status and identify gaps.

Identify and track care gaps (screenings, chronic disease measures, immunizations, monitoring labs) and support closure documentation through established clinic workflows.

Ensure documentation supports quality measures appropriately (clear dates, results, and proof of completion).

Maintain internal tracking for CQV tasks and measure status updates.

3) CPT II Coding for Quality Measures

Apply/assist with CPT II coding for quality reporting and care gap documentation per clinic protocol.

Ensure CPT II codes are supported by chart documentation and entered consistently.

Help reduce missed quality capture by identifying where documentation exists but wasn’t coded.

4) Prior Authorizations & Medication Access Support

Initiate and manage prior authorizations for medications, diagnostics, and procedures as assigned.

Compile required documentation (clinical notes, relevant labs, prior treatment history).

Track PA status, follow payer timelines, and escalate barriers to the team as needed.

Support appeals when requested and within workflow.

5) Documentation, Communication & Workflow Support

Maintain accurate documentation and logs for:

Pre-visit planning completion

Care gaps/CQV findings and actions taken

CPT II codes applied

Prior authorization submissions and outcomes

Communicate efficiently with the provider/clinic team via EHR tasks, secure messaging, or agreed workflow.

Maintain HIPAA-compliant handling of all PHI and work from a secure, private environment.


Required Qualifications:

Outpatient experience (primary care/internal medicine/family medicine preferred).

Strong understanding of preventive care and chronic disease monitoring workflows.

Hands-on experience with prior authorizations and working across payer portals.

Comfort with structured documentation and quality-related chart review.

Preferred Qualifications:

Familiarity with CPT II codes and quality measure documentation.

Experience performing quality portal validation (CQV) and care gap workflows.

Strong EHR experience (Epic preferred if applicable, not required).

Prior remote work experience or demonstrated ability to self-manage and meet deadlines.

Skills & Traits

Highly organized, dependable, and detail-oriented

Clear, concise communicator

Efficient and consistent with documentation

Understands scope and follows established protocols

Comfortable working independently while staying aligned with team workflow

Work Environment & Expectations

Remote/virtual position

Must have reliable internet, secure workspace, and ability to maintain privacy for PHI

Must meet turnaround times for pre-visit planning and PA follow-up

Works closely with the provider/team to reduce missed care gaps and improve visit readiness