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Remote RN

Posted 6 days agoViewed

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šŸ’Ž Seniority level: Junior, 2-3 years

šŸ“ Location: Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois, Louisiana, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, PST

šŸ’ø Salary: 45.0 - 55.0 USD per hour

šŸ” Industry: Health care

šŸ—£ļø Languages: English

ā³ Experience: 2-3 years

šŸŖ„ Skills: SQLComplianceQuality AssuranceRisk ManagementData analytics

Requirements:
  • Clinical expertise in Health care, Clinical documentation, and Medical records management.
  • Experience in OBGYN, Pediatrics, and Inpatient Psychiatry.
  • Minimum 2-3 years of Clinical Documentation Specialist experience.
  • Licensure/Education: IMG with a medical degree or RN license.
  • Certifications: CCDS or CCDIP required.
  • Experience with quality-based reviews, mortality reviews, and risk adjustment tools.
Responsibilities:
  • Conduct concurrent medical record reviews to ensure accurate and complete documentation.
  • Collaborate with physicians and healthcare professionals to clarify and improve documentation.
  • Ensure documentation reflects the severity of illness and quality of care provided.
  • Adhere to MS-DRG classification and compliance regulations.
  • Perform quality-based reviews, mortality reviews, and utilize risk adjustment tools.
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  • Active, unrestricted RN license in the U.S. and in the state of hire OR Active compact multistate RN license (as defined by the Nurse Licensure Compact).
  • Associate Degree in Nursing OR Graduate of an accredited School of Nursing.
  • Two years of clinical experience plus at least two years in one of the following: Home Health, Utilization/Medical Review, Quality Assurance
  • Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
  • Ability to interpret and apply medical review criteria and clinical guidelines.
  • Proficiency in Microsoft Office and word processing software.
  • Strong analytical, organizational, and decision-making skills.
  • Ability to work independently while managing priorities effectively.
  • Excellent customer service, communication, and critical thinking skills.
  • Ability to handle confidential information with discretion.
  • Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
  • Assess payment determinations using clinical information and established guidelines.
  • Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
  • Provide clear, well-documented rationales for service approvals or denials.
  • Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
  • Support quality control activities to meet corporate and team objectives.
  • Provide guidance to LPN team members and support non-clinical staff through training and discussions.
  • Assist with special projects and additional responsibilities as assigned.

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