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