Clinical Review Rn

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
Job Summary:
We are currently looking for Clinical Review RN’s to join our team. These positions are responsible for the review of the admission, resumption, recert and discharge assessments for Medicare, Medicaid, Medicare/Medicaid HMO cases to ensure diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.
Responsibilities Include:

• Audits and reviews Medicare/non-Medicare charts to ensure that proper standards are maintained in compliance with Federal and State regulations.
• Reviews Outcome Assessment Information Set (OASIS) and visit documentation for errors and inconsistencies related to clinical documentation, including wounds
• Applies ICD-10-CM coding rules and regulations to the review process.
• Reviews ICD-10 codes on Medicare/non-Medicare charts for compliance to ICD-9 rules and conventions.
• Discusses findings related to OASIS reviews and advises supervisors and DPS of needed corrections.
• Develops and maintains an effective working relationship with all members of the health care team

Qualifications

• Graduate from an accredited School of Nursing.
• 3-5 years of home care experience
• Strong knowledge of OASIS and Medicare/Medicaid guidelines
• OASIS and or Coding certification preferred
• Strong computer skills
• Excellent verbal and written communication

Physical Requirements
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The above statement are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.
Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.