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Provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services. The goal of concurrent review includes facilitation of appropriate physician documentation of care delivered to accurately reflect patient severity of illness and risk of mortality. Specific reviews are both determined internally and by requirements/requests of external payers or regulatory agencies and play a significant role in reporting quality of care outcomes and in obtaining accurate and compliant reimbursement for acute care services.
Job Responsibility:
Provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services
Facilitation of appropriate physician documentation of care delivered to accurately reflect patient severity of illness and risk of mortality
Specific reviews are both determined internally and by requirements/requests of external payers or regulatory agencies
Play a significant role in reporting quality of care outcomes and in obtaining accurate and compliant reimbursement for acute care services
Requirements:
Associates or Bachelors Degree in Nursing or International Medical Graduate
Minimum of five (5) years of clinical experience in an acute care setting
critical care, medical/surgical or Emergency Department nursing preferred
Computer proficiency to include word processing, databases, and spreadsheets
Familiarity with the operation of basic office equipment
Current RN license in the state in which they reside/practice if Registered Nurse
Knowledge of age-specific needs and elements of disease processes and related procedures required
Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes
Working knowledge of inpatient admission criteria, Medicare reimbursement system and coding systems preferred, but not required
Must possess excellent written and verbal communication skills and critical thinking skills
Ability to work independently in a time oriented environment is essential
Nice to have:
Working knowledge of inpatient admission criteria, Medicare reimbursement system and coding systems
What we offer:
Comprehensive education and training center
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plans
401(K) with company match and discounted stock plan