Top 10 Clinical documentation & utilization review nurses Jobs in Scranton, Pa

Nurse Reviewer RN
Federal Hearings And Appeals —Wilkes-Barre, PA
- $67,500 - $75,000 a year
- Full-time
- RN License
- Mid-level
- Analysis skills
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RN REGISTERED NURSE ASSESSMENT COORDINATOR
Elan Skilled Nursing —Scranton, PA
- From $42 an hour
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
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Utilization Specialist
Geisinger Behavioral Health Center Northeast —Moosic, PA
- Full-time
- CPR Certification
- Nursing
- RN License
9d
MDS/Admission RN
Commonwealth Health —Wilkes-Barre, PA
- Part-time
- Nursing
- RN License
- Hospital
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Utilization Specialist
Geisinger Behavioral Health Center Northeast —Moosic, PA
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or…
9d
RN REGISTERED NURSE ASSESSMENT COORDINATOR
Elan Skilled Nursing —Scranton, PA
Must posses a valid Pennsylvania nursing license. Ensures that all facility procedures related to the RAI process are followed to maintain all state and federal…
From $42 an hour
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Current, active Registered Nurse (RN) license. Ensure timely and accurate completion of all MDS assessments in accordance with federal and state regulations.
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Nurse Reviewer RN

Federal Hearings And Appeals
Wilkes-Barre, PA

Quick Apply

Job Details

Full-time
$67,500 - $75,000 a year

Qualifications

Computer operation
RN License
Computer skills
Nursing

Full Job Description

Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other type of medical claims;
Provide timely review and determination of medical claims;
Analyze medical records related to the case file;
Review and interpret Local Coverage Determination (LCD), National Coverage Determination (NCD) policies, and other federal regulations;
Apply appropriate regulatory citations, including health plan policies, NCD/LCDs, and/or other regulations to each claim as it relates to the item or issue;
Formulate a narrative decision citing relevant regulatory back-up documentation contained within the medical record;
Adjudicate claim based on the regulations and documentation contained within the medical record;
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification through the American Academy of Professional Coders (AAPC) or AHIMA preferred;
Maintain professional licensure in active and unrestricted status as required by state of issuance;
Attend FHAS and/or client Lunch & Learn sessions and/or general training sessions on site as needed.
Complete IRR surveys in a timely fashion as required by the prime contractor
Maintain a 97% or higher quality score

work experience requirements

Must possess a current, unrestricted State license as a Registered Nurse (RN),as required by contract(s).
1+ years clinical experience required; coding, utilization, and/or medical chart review preferred.
Professional Coding Certification preferred.
Detailed knowledge of Medicare regulations and guidelines, polices, and payor reimbursements preferred.
Knowledge of CPT, HCPCS, ICD-10 codes and coding guidelines.
Ability to identify Medicare billing and payment irregularities.
Must be able to support review findings by utilizing exceptional analytical, written and oral communication skills.
Ethical, self-motivated and results oriented team player.
Strong analytical, verbal and written communication skills.
Outstanding people skills and ability to effectively review findings /results with management.
Must be proficient with PC and related software programs.
Excellent organizational skills.
Must be a team player.
Limited travel may be required.

physical requirements

Must be able to remain in the stationary position 95% of the time
Constantly operate a computer and other office equipment such as telephone
Regular & predictable attendance is essential for this position

Remote but need to be local to 18702

RN required

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Refine Your Search

clinical documentation & utilization review nurses jobs in scranton, pa

Nurse Reviewer RN

RN REGISTERED NURSE ASSESSMENT COORDINATOR

Utilization Specialist

MDS/Admission RN

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