Top 10 Clinical documentation & utilization review nurses Jobs in Clive, Ia

Medical Review Nurse (AIMRR) 2
EPATHUSA INC —Clive, IA
- $76,875 - $97,375 a year
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science in Nursing
Senior Review Coordinator (Oncology) - Utilization Management (RN)
Telligen —West Des Moines, IA
- Email
- Hybrid work
- Nursing
- RN License
- Research
Quick Apply
REMOTE MDS Coordinator
MDS Solutions —Des Moines, IA
- Part-time
- Remote
- RN License
- Customer service
- Mid-level
- Health savings account
- Paid holidays
4d
Travel MDS Coord RN/LPN
WesleyLife —Johnston, IA
- Travel nursing
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
RN Quality Coordinator - Hybrid
MercyOne —Des Moines, IA
- Full-time
- Nursing
- RN License
- 5 years
MDS Coordinator
Cedar Ridge Village —West Des Moines, IA
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Continuing education credits
- Health insurance
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills

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Senior Review Coordinator (Oncology) - Utilization Management (RN)
Telligen —West Des Moines, IA
Current RN license that is recognized in the relevant jurisdiction(s)or other certification directly relevant to the type of review performed; Ability to obtain…
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Utilization Review Specialist - Autism
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Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Clinical Finance Case Management Specialist 2
The Ohio State University Wexner Medical Center —Columbus, OH
Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices required.

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clinical documentation & utilization review nurses jobs near clive, ia

Medical Review Nurse (AIMRR) 2

EPATHUSA INC -
Clive, IA

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Job Details

Full-time
$76,875 - $97,375 a year

Qualifications

Utilization review
RN License

Full Job Description

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, clinical review judgment and when appropriate, monitor for potential indicators of fraud, waste, and abuse. Provides professional assessment, planning, coordination, implementation, and reporting of complex data to support the Medical Review Accuracy Contract (MRAC).

Essential Functions

Perform complex medical record and claims review in accordance with all State and Federal mandated regulations/guidelines.
Accurately enter medical review data into the medical review system.
Apply clinical review judgment, based on clinical experience when applicable and review completeness of documentation to determine if documentation supports claim as billed.
Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification.
When performing Program Integrity (PI) reviews, assess investigative allegations and medical review findings, and/or other claims data to determine patterns and detect potential indicators of fraud, waste and abuse (FWA).
Accurately identify additional findings in the review of evidence of potential FWA not detected by the Medical Review Contractor.
Consistently meet or exceed productivity and accuracy standards of 98% minimum IRR established by the customer and/or the Company.

Registered Nurse, with a current unobstructed license to practice nursing in the United States. Graduate of a Board approved Registered Nursing program.
A Bachelor’s Degree in Nursing (BSN) or other related field is preferred.
Certification in coding highly preferred.
A minimum of five (5) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice.
A minimum of three (3) or more years’ experience in medical/utilization medical record review particularly with Medicare and/or Medicaid.
Minimum of 2 (two) years’ experience in the medical review processes of MACs, SMRC, CERT, QICs and/or BFCC-QIOs.
Desired experience performing medical review for fraud, waste, and abuse (FWA) investigations.
Knowledgeable of ICD-9-CM, ICD-10, CPT-4 and HCPCS coding.
One year or more of utilizing InterQual and/or Milliman guidelines against inpatient services experience is preferred.

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clinical documentation & utilization review nurses jobs in clive, ia

Medical Review Nurse (AIMRR) 2

Senior Review Coordinator (Oncology) - Utilization Management (RN)

REMOTE MDS Coordinator

Travel MDS Coord RN/LPN

RN Quality Coordinator - Hybrid

MDS Coordinator

Appeals Professional III (Licensed Clinician)

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