Medical Review Nurse
New
M
MachinifyHealthcare intelligence
Remote - USFull-TimeMiddle
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- 2 years or more
Requirements
- Associate or bachelor’s degree in nursing.
- Active/unrestricted RN license.
- 2+ years experience in inpatient claims auditing, quality assurance, recovery auditing, or Inpatient Clinical Documentation Integrity.
- Required certification: CCDS, CDIP, CCS, or CIC.
- Experience with utilization management systems or clinical decision-making tools (e.g., MCG, InterQual).
- Deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding.
- Expert in DRG methodologies (MS & APR).
- In-depth knowledge of clinical criteria and documentation requirements.
- Proficiency in standard office computer technology (email, SharePoint, Slack, Outlook).
- Ability to manage multiple tasks and strict deadlines.
Responsibilities
- Audit claims for medically appropriate services provided for inpatient settings while applying appropriate medical review guidelines, policies and rules.
- Document all findings referencing the appropriate policies and rules.
- Generate letters articulating audit findings.
- Support your findings during the appeals process if requested.
- Work collaboratively with the audit team to identify potential vulnerabilities or cases subject to abuse.
- Keep abreast of medical practice, technology changes, and regulatory issues.
- Assist with QA functions and training team members.
- Cross train in all clinical departments/areas.
View Full Description & ApplyYou'll be redirected to the employer's site
