Top 6854 Rn / Lvn Jobs

Inpatient DRG Reviewer
Zelis —Saint Petersburg, FL
- $79,000 - $99,750 a year
- Full-time
- Hybrid work
- LVN
- RN License
- Mid-level
- Paid holidays
- Disability insurance
Director of Staff Development (DSD)- 1 year of experience required and Licensed Nurse LVN or RN
The Gardens Healthcare Center —Northridge, CA
- $40 - $46 an hour
- Full-time
- Skilled nursing facility
- LVN
- RN License
- Paid holidays
- Disability insurance
Quick Apply
Health Services Administrator - RN or LVN
Core Civic —California City, CA
- $147,475 a year
- Full-time
- Nursing
- Medication administration
- LVN
MDS Coordinator LVN/RN
Auburn Oaks Care Center —Auburn, CA
- $52.88 - $76.92 an hour
- Full-time
- Background check
- Skilled nursing facility
- LVN
- Health savings account
- Health insurance
Quick Apply
2d
Clinical Coordinator LVN Program- RN Required
Concorde Career Colleges, Inc. —Jacksonville, FL
- Nursing
- RN License
- Clinic experience
- Paid parental leave
- Health insurance
Clinical Reviewer (BHJOB1435_35508)
Astyra Corporation —Indianapolis, IN
- $38 - $40 an hour
- Weekends as needed
- Remote
- Background check
- Nursing
- LVN
- Health insurance
- Dental insurance
Quick Apply
5d
Utilization Management Nurse, LVN/LPN
NeueHealth —Remote
- $26.35 - $39.53 an hour
- Remote
- Nursing
- LVN
- RN License
- Paid holidays
- Health insurance
Quick Apply
Utilization Management Nurse (Sun–Thurs or Tues–Saturday)
Curana Health —Remote
- Weekends as needed
- Nursing
- LVN
- Mid-level
Registered Nurse (RN)
Eden Senior Care —Pine Island, MN
- $39.75 - $44.13 an hour
- Full-time
- Nursing
- Skilled nursing facility
- Management
- Loan repayment program
- Health insurance
Quick Apply
Licensed Vocational Nurse (LVN)
Adaptive Home Health —Aurora, CO
- $46 per point
- Full-time
- LVN
- Patient monitoring
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
LVN / RN - Low Acuity, Full-Time - Pediatric Home Health
Entrusted Fort Worth —Cleburne, TX
- Up to $35 an hour
- 12 hour shift
- Background check
- Spanish
- CPR Certification
- Paid training
- Paid holidays
Quick Apply
4d
Licensed Vocational Nurse (LVN) Home Care
First Place Pediatrics LLC —Austin, TX
- $25 - $30 an hour
- Part-time
- CPR Certification
- Nursing
- LVN
- Paid time off
- Referral program
Quick Apply
Private Duty Full Time Night RN or LVN for Infant
Pediatric Home Service —Waxahachie, TX
- Part-time
- LVN
- RN License
- Children
- Health insurance
- Dental insurance
Quick Apply
Licensed Nurse - Delaware Plaza
Delaware Plaza —Longview, WA
- $32 - $40 an hour
- Full-time
- RN License
- Nursing home
- Pass drug screening
- Health savings account
- Paid holidays
Quick Apply
12d
OR Scrub Technician / LVN
Comanche County Medical Center —Comanche, TX
- Full-time
- Surgery
- LVN
- BLS Certification
Quick Apply
2d
Field LPN or RN for pediatric respite care (PRN)
Basin Home Health & Hospice —Farmington, NM
- $25 an hour
- Part-time
- LVN
- Writing skills
- BLS Certification
- Flexible schedule
Quick Apply
Clinical Liaison - Northern Milwaukee Territory - $10,000 Sign-On Bonus
ClearSky Rehabilitation Hospital Lakeshore, LLC —Cleveland, WI
- Full-time
- Clean driving record
- LVN
- RN License
- Continuing education credits
- Loan repayment program
Quick Apply
12d
Registered Nurse
Riverbend of South Natick —Natick, MA
- From $45 an hour
- Part-time
- Background check
- CPR Certification
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
Health Home RN Case Manager
Renew Home Health —Denton, TX
- Full-time
- Background check
- CPR Certification
- Management
- Health savings account
- Health insurance
Quick Apply
Charge Nurse - LVN or RN*** $2,500 Sign-On Bonus ***
Parkview Manor —Weimar, TX
- Full-time
- Nursing
- LVN
- RN License
- AD&D insurance
- Disability insurance
Quick Apply

I want to receive the latest job alert for Rn / Lvn

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Rn / Lvn jobs near

Inpatient DRG Reviewer

Zelis -
Saint Petersburg, FL

Apply Now

Job Details

Full-time
$79,000 - $99,750 a year

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Prescription drug insurance

Qualifications

Defect resolution root cause analysis
Inpatient experience
Medicare
LVN
RN License
Audit report preparation
Process optimization
Health insurance policy knowledge
Process improvement
Healthcare documentation compliance audits
Medical billing compliance checks
Mid-level
Audit Reporting
Evidence-based practice
Retrospective medical coding audits
Medicare regulations
Document review
Organizational skills
Root cause analysis
Insurance claims auditing
Clinical documentation standards
Healthcare claims compliance audits
Standard operating procedures (SOPs)
Communication skills
DRG

Full Job Description

Description

At Zelis, we Get Stuff Done. So, let’s get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

A Little About You

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

As part of the Price Optimization division, this role is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients.

What you will do:

Perform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best practice, etc.
Perform readmission reviews, including evaluating prior and current admissions to determine preventability, relatedness, and compliance with readmission policies.
Based on the evidence presented in the medical records, determine, and record the appropriate (revised) Diagnosis Codes, Procedure Codes and Discharge Status Code applicable to the claim.
Using the revised codes, regroup the claim using provided software to determine the ‘new DRG’
Where the regrouped ‘new DRG’ differs from what was originally claimed by the provider, write a customer facing ‘rationale’ or ‘findings’ statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review
Document all aspects of audits including uploading all provider communications, clinical rationale, and/or financial research
Identify new DRG coding concepts to expand the DRG product.
Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures
Meet and/or exceed all internal and department productivity and quality standards
Recommend new methods to improve departmental procedures
Achieve and maintain personal production and savings quota
Maintain awareness of and ensure adherence to Zelis standards regarding privacy

What you will bring:

RN or LVN required
Inpatient Coding Certification required (CCS, CIC) within 4 – 6 months of hire date
1 -3 years reviewing and or auditing ICD-10 CM, MS-DRG and APPR-DRG claims preferred
Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
Experience performing readmission reviews, including evaluating relatedness, preventability, and compliance with readmission policies
Understanding of hospital coding and billing rules
Clinical skills to evaluate appropriate Medical Record Coding
Experience conducting root cause analysis and identifying solutions
Strong organization skills with attention to detail
Outstanding verbal and written communication skills

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Base Salary Range

$79,000.00 - $99,750.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [email protected].

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.

Apply Now

Refine Your Search

Rn / Lvn jobs

Inpatient DRG Reviewer

Director of Staff Development (DSD)- 1 year of experience required and Licensed Nurse LVN or RN

Health Services Administrator - RN or LVN

MDS Coordinator LVN/RN

Clinical Coordinator LVN Program- RN Required

Clinical Reviewer (BHJOB1435_35508)

Utilization Management Nurse, LVN/LPN

Utilization Management Nurse (Sun–Thurs or Tues–Saturday)

Registered Nurse (RN)

Licensed Vocational Nurse (LVN)

LVN / RN - Low Acuity, Full-Time - Pediatric Home Health

Licensed Vocational Nurse (LVN) Home Care

Private Duty Full Time Night RN or LVN for Infant

Licensed Nurse - Delaware Plaza

OR Scrub Technician / LVN

Field LPN or RN for pediatric respite care (PRN)

Clinical Liaison - Northern Milwaukee Territory - $10,000 Sign-On Bonus

Registered Nurse

Health Home RN Case Manager

Charge Nurse - LVN or RN* $2,500 Sign-On Bonus *

I want to receive the latest job alert for Rn / Lvn

Related Searches

Explore jobs in more locations

Description

Job Seeker Tools

Employer Tools

Browse

Stay Connected