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Clinical Review Nurse Jobs in Iowa

Medical Review Nurse Auditor
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision making tools such as MCG or InterQual.
Other duties, responsibilities, and qualifications may be required and/or assigned as necessary
Typing skills and working knowledge of computer functions and applications such as MS office (Outlook, Word, Excel).
Works collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential Fraud Waste and Abuse (FWA).
Maintain a current knowledge of Medicare and Commercial regulations, policies and procedures
Maintain coding certification to ensure eligibility to perform audits on behalf of Performant
Clinical Review Coordinator - National Remote
By Optum At , Dallas, 75202
2+ years of Case Management experience
Experience in acute care, rehab, OR skilled nursing facility environment
Ability to work effectively in a self- management environment
Support new delegated contract start - up to ensure experienced staff work with new contracts
Perform other duties and responsibilities as required, assigned or requested
3+ years of clinical experience
Medical Review Nurse (Government Outpatient Clinical Focus)
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Medical Review Nurse (Snf Focus)
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Medical Review Nurse (Readmissions Focus)
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Excellent written and verbal communication skills.
Ability to manage multiple tasks including desk audits and claims review.
Minimum of three years diversified nursing experience providing direct care in an inpatient or outpatient setting.

Are you a Clinical Review Nurse looking for a new challenge? Join our team and help us make a difference in the lives of our patients! We offer a competitive salary and benefits package, flexible hours, and a supportive team environment. Come join us and make a positive impact in the healthcare industry!

Overview:

A Clinical Review Nurse is a healthcare professional who is responsible for reviewing medical records and making decisions about the appropriateness of care provided to patients. They are responsible for ensuring that the care provided is in accordance with established standards of practice and that it is medically necessary. Clinical Review Nurses also provide guidance to healthcare providers on the most appropriate course of treatment for a patient.

Detailed Job Description:

Clinical Review Nurses are responsible for reviewing medical records to ensure that the care provided is medically necessary and in accordance with established standards of practice. They must be able to interpret medical records and make decisions about the appropriateness of care provided. Clinical Review Nurses must also be able to provide guidance to healthcare providers on the most appropriate course of treatment for a patient. They must be able to communicate effectively with healthcare providers and patients to ensure that the care provided is appropriate and meets the patient's needs.

What is Clinical Review Nurse Job Skills Required?

• Knowledge of medical terminology and anatomy
• Knowledge of medical coding and billing
• Knowledge of healthcare regulations and standards
• Ability to interpret medical records
• Ability to make decisions about the appropriateness of care provided
• Ability to provide guidance to healthcare providers
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team

What is Clinical Review Nurse Job Qualifications?

• Bachelor’s degree in Nursing or a related field
• Current Registered Nurse (RN) license
• Certification in Clinical Review Nursing (CCRN)
• Experience in a clinical setting
• Knowledge of medical coding and billing

What is Clinical Review Nurse Job Knowledge?

• Knowledge of medical terminology and anatomy
• Knowledge of healthcare regulations and standards
• Knowledge of medical coding and billing
• Knowledge of clinical review processes

What is Clinical Review Nurse Job Experience?

• Experience in a clinical setting
• Experience in medical coding and billing
• Experience in clinical review processes

What is Clinical Review Nurse Job Responsibilities?

• Review medical records to ensure that the care provided is medically necessary and in accordance with established standards of practice
• Interpret medical records and make decisions about the appropriateness of care provided
• Provide guidance to healthcare providers on the most appropriate course of treatment for a patient
• Communicate effectively with healthcare providers and patients to ensure that the care provided is appropriate and meets the patient's needs
• Monitor patient outcomes to ensure that the care provided is effective
• Maintain accurate records of all reviews and decisions made