RN Clinical Reviewer / Utilization Review
Job Title: Registered Nurse Medical Reviewer Summary Description The Reviewer utilizes clinical expertise for the review of Home Health and Skilled Nursing Facility medical records against appropriate criteria and payment models in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness and appropriate use of HIPPS codes while maintaining production goals and QA standards. Education Active unrestricted RN clinical license; Graduation from an accredited Diploma, Associates Degree or Bachelor’s Degree Program Experience • Knowledge of Medicare/Medicaid criteria strongly preferred • Knowledge of the organization of medical records, medical terminology, and disease process required • Strong clinical assessment and critical thinking skills required • Excellent verbal and written communication skills required • Must be proficient in Microsoft Office and internet/web navigation • Minimum three (3) years of clinical experience in an acute care, skilled nursing facility, home health or med-surgical environment required • Must understand HIPPS coding • Medical Coding experience is desirable Job Type: Full-time, work at home position. J Job Type: Full-time Pay: $30.00 - $35.00 per hour Education: • Associate (Required) Experience: • Clinical: 3 years (Preferred) License/Certification: • RN (without restrictions) (Required) Work Location: Remote Apply tot his job