Top 393 Senior nurse Jobs in Virginia

Sr. Nurse Reviewer (Medicare)
Commence —Virginia
- $88,000 - $115,000 a year
- Online Application
- Remote
- Nursing
- Management
- RN License
1d
Clinical Coordinator, RN - Primary Care Shirlington
VHC Health —Arlington, VA
- $78,582.40 - $143,000.00 a year
- Full-time
- Nursing
- RN License
- Primary Care
- Health insurance
- Dental insurance
Clinical Coordinator, RN - Primary Care McLean
VHC Health —Arlington, VA
- $78,582.40 - $143,000.00 a year
- Full-time
- Nursing
- RN License
- Primary Care
- Health insurance
- Dental insurance
12d
Nursing Care Director
Sunrise Senior Living —Falls Church, VA
- $89,128 - $123,032 a year
- Full-time
- Nursing
- Recruiting
- Senior level
- Paid holidays
- Health insurance
Manager of Health at Home Inpatient
VCU Health System —Richmond, VA
- $92,290 - $152,277 a year
- Full-time
- Nursing
- 5 years
- Office
1d
Nurse Practitioner Clinical Advisor - Senior Care - Eastern Virginia - Optum
Optum —Chesapeake, VA
- $115,000 - $172,000 a year
- Full-time
- Nursing
- Certified Nurse Practitioner
- Pass drug screening
Quick Apply
8d
Outpatient Clinical Supervisor - Primary Care
Inova Health System —Virginia
- Full-time
- Nursing
- BLS Certification
- Primary Care
- Wellness program
- Health insurance
12d
Director of Nursing, RN
Silverado —Alexandria, VA
- $150,000 - $170,000 a year
- Background check
- Clean driving record
- Current TB test
- Health insurance
- Dental insurance
Quick Apply
10d
Resident Care Director RN
Sunrise Senior Living —Reston, VA
- $89,128 - $123,032 a year
- Full-time
- Nursing
- Recruiting
- Senior level
- Paid holidays
- Health insurance
Licensed Practical Nurse (LPN)
Trio Healthcare —Berryville, VA
- LPN
- Entry level
- Paid time off
Quick Apply
LPN
Trio Healthcare —Galax, VA
- LPN
- Entry level
- Paid time off
Quick Apply
Licensed Practical Nurse (LPN)
Oakwood Health and Rehab Center —Bedford, VA
- $31.00 - $37.04 an hour
- Full-time
- CPR Certification
- Skilled nursing facility
- BLS Certification
- Continuing education credits
- Paid holidays
Quick Apply
Registered Nurse
Staunton Post Acute & Rehabilitation —Staunton, VA
- $39.00 - $44.59 an hour
- Full-time
- CPR Certification
- Skilled nursing facility
- RN License
- Continuing education credits
- Paid holidays
Quick Apply
Licensed Practical Nurse
Staunton Post Acute & Rehabilitation —Staunton, VA
- $31.00 - $37.04 an hour
- Full-time
- CPR Certification
- Skilled nursing facility
- BLS Certification
- Continuing education credits
- Paid holidays
Quick Apply
RN Supervisor
Ashland Nursing and Rehabilitation —Ashland, VA
- $40 - $45 an hour
- Weekends as needed
- Skilled nursing facility
- RN License
- Mid-level
- Paid holidays
- Dental insurance
Quick Apply
3d
Registered Nurse (RN)
Holly Manor Rehab and Nursing —Farmville, VA
- $39.00 - $44.59 an hour
- Part-time
- CPR Certification
- Skilled nursing facility
- RN License
- Continuing education credits
- Paid holidays
Quick Apply
Registered Nurse
Skyview Springs Rehab & Nursing —Luray, VA
- $38 - $43 an hour
- Part-time
- CPR Certification
- Skilled nursing facility
- RN License
- Continuing education credits
- Paid holidays
Quick Apply
License Practical Nurse (LPN)
Guggenheimer Health & Rehab Center —Lynchburg, VA
- $31 - $35 an hour
- Full-time
- CPR Certification
- Skilled nursing facility
- BLS Certification
- Continuing education credits
- Paid holidays
Quick Apply
Unit Manager- RN
Trio Healthcare —Berryville, VA
- Nursing
- Skilled nursing facility
- Mid-level
- Paid time off
Quick Apply
Registered Nurse (RN)
Trio Healthcare —Berryville, VA
- Skilled nursing facility
- RN License
- Mid-level
- Paid time off
Quick Apply

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Sr. Nurse Reviewer (Medicare)

Commence
Virginia

Apply Now

Job Details

Full-time
$88,000 - $115,000 a year
1 day ago

Qualifications

Confidential information handling
Management
Medicare
RN License
Team development
Bachelor's degree
Medicare regulations
Clinical staff mentoring
Centers for Medicare and Medicaid Services (CMS)
Patient care
Centers for Medicare & Medicaid Services (CMS) billing regulations

Full Job Description

Description:

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.?

Requirements:

The Senior Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical judgment in order to assess the potential for overpayment or fraud. Using established criteria/ and clinical guidelines, the Senior Nurse Reviewer is responsible for making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care.

The Senior Nurse reviewer may also have responsibilities for managing and overseeing the medical review work of a team, to include various quality review activities along with the development of training materials. The Senior Nurse Reviewer is responsible for driving continuous improvement by identifying and implementing process enhancements, while supporting team accountability and maintaining high-quality performance standards.

Required Qualifications

Bachelor's degree in nursing or a related healthcare field
Active, unrestricted RN license; compact multistate RN license acceptable
5+ years of clinical experience, including 3+ years of Medicare-related utilization review, medical review, or claims review experience
Demonstrated experience providing guidance, mentorship, or lead-level direction to other clinical reviewers (RN/LPN) and/or coding staff
Extensive knowledge of Medicare coverage, coding, and payment rules, including NCD/LCD application
Strong analytical, written, and verbal communication skills; ability to handle confidential/sensitive information with discretion

Preferred Qualifications

Prior experience as a senior/lead reviewer or “Medical Reviewer III”-equivalent on a MAC, RAC, QIO, or SMRC-type contract
Experience participating in inter-rater reliability or peer-review quality assurance programs
CPC (or similar) coding certification
Experience supporting case file preparation for Administrative Law Judge (ALJ) hearing participation

Key Responsibilities

Conduct the highest-complexity and escalated clinical medical reviews, including reassigned cases where the original reviewer is no longer available, consistent with SOW continuity requirements for Discussion & Education sessions
Serve as a mentor and technical resource for Nurse Reviewers and Certified Coders on complex, mixed clinical/coding claims
Lead or contribute to inter-rater reliability and peer-review QA activities supporting the SOW's required 95%+ monthly accuracy standard
Contribute to development and maintenance of medical review training materials and the Quality Control assessment plan
Monitor team-level accuracy and quality trends; recommend corrective actions and process improvements to the Medical Review Manager
Support vulnerability identification and trend/root-cause analysis for Program Integrity reviews
Complete required annual CMS trainings and maintain HIPAA/PHI compliance

Work Environment/Physical Demands

The work environment and physical demands 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.

This is a remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Commence is an equal employment opportunity for employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or [email protected]. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.

Apply Now

Refine Your Search

senior nurse jobs in virginia

Sr. Nurse Reviewer (Medicare)

Clinical Coordinator, RN - Primary Care Shirlington

Clinical Coordinator, RN - Primary Care McLean

Nursing Care Director

Manager of Health at Home Inpatient

Nurse Practitioner Clinical Advisor - Senior Care - Eastern Virginia - Optum

Outpatient Clinical Supervisor - Primary Care

Director of Nursing, RN

Resident Care Director RN

Licensed Practical Nurse (LPN)

LPN

Licensed Practical Nurse (LPN)

Registered Nurse

Licensed Practical Nurse

RN Supervisor

Registered Nurse (RN)

Registered Nurse

License Practical Nurse (LPN)

Unit Manager- RN

Registered Nurse (RN)

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