Register
Recruit Create CV

DRG Nurse Reviewer Jobs

Nurse Reviewer Jobs
By Medical Mutual of Ohio At ,
Keeps up to date on utilization management regulations, policies and practices.
Acute inpatient level of care in Medical/Surgical/Critical Care/ ambulatory care experience preferred.
Intermediate Microsoft Office skills and proficiency navigating windows and web-based systems.
Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
Knowledge of clinical practices and efficient care delivery processes.
Education reimbursement up to $5K per year
Clinic Risk Nurse Reviewer (Remote)
By Mercy At , Oklahoma City, 73120
Experience: At least 1 year of clinical experience
Education: Associate's or Bachelor's Degree
*This is a Remote Position*
*Strongly Prefer HCC Coding Experience*
*Looking for Clinic Nurse Reviewer/Risk Coder*
We're bringing to life a healing ministry through compassionate care.
Clinic Risk Nurse Reviewer (Remote)
By Mercy At , Oklahoma City, 73120, Ok
Experience: At least 1 year of clinical experience
Education: Associate's or Bachelor's Degree
*This is a Remote Position*
*Strongly Prefer HCC Coding Experience*
*Looking for Clinic Nurse Reviewer/Risk Coder*
We're bringing to life a healing ministry through compassionate care.
Nurse Reviewer - Remote
By The Computer Merchant, LTD (TCM) At Anchorage, AK, United States

JOB TITLE:Nurse Reviewer - Remote

Drg Validation Claims Reviewers
By RevCycle Xpert Corp At United States
Experience working in a remote environment.
·Expert inpatient coding skills with superior knowledge of regulatory ICD-10-CM / PCS
Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
Excellent communication skills written and verbal.
Thorough understanding of the revenue cycle and the various DRG Groupers necessary for case assignments & payor-specific billing/reimbursement.
3+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred.
Drg Validator Jobs
By Pivotal Placement Services, Inc At United States
Appeals and Charge Capture experience required
Nurse audit, provider revenue integrity, or payor audit experience preferred
This position is remote! Live anywhere in the United States!
Performing DRG validation (clinical/coding) reviews of medical records
Completing medical records review, accurately documenting findings and non-findings, and providing clinical/policy/regulatory support for the determination
CPC, CCS, and RHIT required
Nurse Reviewer - Remote
By Fortuna BMC At United States
Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
Demonstrated proficiency in computer skills, and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, etc.
5+ years clinical experience in an inpatient hospital setting required
Nurse Reviewer - Remote
By Fortuna BMC At Cochiti Pueblo, NM, United States
Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
Demonstrated proficiency in computer skills, and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, etc.
5+ years clinical experience in an inpatient hospital setting required
Nurse Reviewer Jobs
By Fortuna BMC At United States
• Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
Remote or hybrid or in person and shift hours will be Alaska time
• Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
• 5+ years clinical experience in an inpatient hospital setting required
• 2+ years utilization review experience or claims auditing required
• Experience using Milliman or InterQual criteria required
Nurse Reviewer I-9 Jobs
By Elevance Health At Illinois, United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Nurse Reviewer I-9 Jobs
By Elevance Health At Rhode Island, United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Nurse Reviewer I-9 Jobs
By Elevance Health At Florida, United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Nurse Reviewer I-9 Jobs
By Elevance Health At United States
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred.
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network.
Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
Professional Reviewer - Nurse Anesthetists (Crna) - Remote
By Michigan Peer Review Organization At , Remote
Use your clinical knowledge to improve the quality of health care.
Enjoy the convenience of reviewing cases remotely.
Must have a minimum of three years of clinical experience in your specialty.
Join a pool of professionals who are experts in their specialties.
Protect the integrity of your medical specialty.
Provide final determinations regarding medical necessity and quality of care issues.
Nurse Reviewer I Jobs
By Elevance Health At , Deerfield, Il
Previous utilization and/or quality management and/or call center experience preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Candidates must have good computer skills and solid typing speed and accuracy.
Nurse Reviewer I Preferred Qualifications:
Nurse Reviewer (Level I) Soft Skills:
Job Family: Medical and Clinical
Nurse Reviewer I Jobs
By Elevance Health At , Cerritos, 90703, Ca
Previous utilization and/or quality management and/or call center experience preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Candidates must have good computer skills and solid typing speed and accuracy.
Nurse Reviewer I Preferred Qualifications:
Nurse Reviewer (Level I) Soft Skills:
Job Family: Medical and Clinical
Nurse Reviewer I Jobs
By Elevance Health At Illinois, United States
Previous utilization and/or quality management and/or call center experience preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Candidates must have good computer skills and solid typing speed and accuracy.
Job Family: Medical and Clinical
Receives pre-authorization requests from front-line intake
Conducts initial medical necessity clinical screening
Nurse Reviewer (Associate Or Level I)
By Elevance Health At Grand Prairie, TX, United States
Quality management and/or call center experience is a plus
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Customer service experience is preferred.
Any experience in clinical nursing experience is a plus
Nurse Reviewer (Associate Or Level I)
By Elevance Health At Illinois, United States
Quality management and/or call center experience is a plus
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Customer service experience is preferred.
Any experience in clinical nursing experience is a plus
Nurse Reviewer (Associate Or Level I)
By Elevance Health At Wixom, MI, United States
Quality management and/or call center experience is a plus
Previous utilization and/or quality management and/or call center experience preferred.
Familiarity with Utilization Management Guidelines preferred.
Documents the results of the initial clinical review and determination in the pre-certification computer system
Customer service experience is preferred.
Any experience in clinical nursing experience is a plus

Are you looking for an exciting opportunity to use your nursing expertise to make a difference? Join our team as a DRG Nurse Reviewer and help us ensure quality care for our patients! You'll have the chance to use your clinical knowledge to review and analyze medical records, identify coding discrepancies, and provide feedback to ensure accuracy and compliance. Plus, you'll get to work with a great team of professionals in a fast-paced environment. Don't miss out on this amazing opportunity – apply today!

Overview:

A DRG Nurse Reviewer is a healthcare professional who is responsible for reviewing medical records and coding them according to the Diagnosis Related Group (DRG) system. The DRG Nurse Reviewer is responsible for ensuring that the medical records are coded accurately and that the reimbursement for the services provided is appropriate.

Detailed Job Description:

The DRG Nurse Reviewer is responsible for reviewing medical records and coding them according to the DRG system. The DRG Nurse Reviewer must have a thorough understanding of the DRG system and be able to accurately code the medical records. The DRG Nurse Reviewer must also be able to identify any discrepancies in the medical records and make corrections as needed. The DRG Nurse Reviewer must also be able to identify any potential areas of improvement in the coding process and make recommendations to improve the accuracy and efficiency of the coding process.

What is DRG Nurse Reviewer Job Skills Required?

• Knowledge of the DRG system and coding guidelines
• Ability to accurately code medical records
• Ability to identify discrepancies in medical records
• Ability to identify areas of improvement in the coding process
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team

What is DRG Nurse Reviewer Job Qualifications?

• Bachelor’s degree in nursing or a related field
• Current RN license
• Certification in medical coding
• Experience in medical coding and DRG coding
• Knowledge of medical terminology

What is DRG Nurse Reviewer Job Knowledge?

• Knowledge of the DRG system and coding guidelines
• Knowledge of medical terminology
• Knowledge of reimbursement systems
• Knowledge of medical coding systems

What is DRG Nurse Reviewer Job Experience?

• Previous experience in medical coding and DRG coding
• Previous experience in healthcare reimbursement
• Previous experience in medical record review

What is DRG Nurse Reviewer Job Responsibilities?

• Review medical records and code them according to the DRG system
• Identify discrepancies in medical records and make corrections as needed
• Identify areas of improvement in the coding process and make recommendations
• Ensure accuracy and efficiency of the coding process
• Maintain accurate records of coding activities
• Communicate with other healthcare professionals as needed