RN Clinical Reviewer

#LI-HW1 #LI-Remote

Essential Functions and Primary Duties

• Review resident medical records for accuracy, completeness and consistency with professional standards
• Participate in remote and on-site field examinations of Medicaid providers to review clinical documentation
• Successfully interact with providers in a professional manner, developing rapport and enhancing business relationships
• Maintain security of and confidentiality of all Protected Health Information (PHI)
• Additional responsibilities as assigned

Preferred Qualifications

• Bachelor’s degree in Nursing or other related health care field required (Associate’s Degree from accredited nursing school with related experience may be substituted in lieu of a bachelor’s degree)
• Must be a licensed Registered Nurse (RN)
• Minimum 3 years of long term care experience required; 5 years preferred
• MDS experience preferred
• Experience and knowledge of State and Federal healthcare regulations in long term care
• Knowledge of Medicaid reimbursement and coverage policies desired
• Proficient use of applicable software programs, including Microsoft Windows, Word, Excel
• Strong verbal and written communication skills
• Ability to manage multiple deadlines and prioritize assignments
• Ability to work in a team environment
• Well organized with a high degree of accuracy and attention to detail
• Must be able to travel based on client and business needs (up to 20% Travel)

Minimum Qualifications

• High school diploma or GED