Top 48 Nurse case reviewer (home based) Jobs

Second Level Reviewer I PRN Remote
AdventHealth Corporate —Altamonte Springs, FL
- $31.82 - $59.17 an hour
- PRN
- Remote
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
Clinical Quality Reviewer - REMOTE - LCSW OR RN - US Citizen Required
TEEMA —Phoenix, AZ
- $41 - $44 an hour
- Full-time
- Remote
- Nursing
- Surgery
- RN License
Quick Apply
Clinical Quality Reviewer - REMOTE - RN - US Citizen Required
TEEMA —Phoenix, AZ
- $41 - $44 an hour
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
Quick Apply
Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
- Disability insurance
- Dental insurance
Quick Apply
DRG Nurse Reviewer Appeals and Hearings- Remote
Gainwell Technologies —Florida
- $95,000 - $110,000 a year
- Full-time
- Remote
- RN License
- Presentation skills
- Travel
- Health insurance
- Tuition reimbursement
Utilization Management Registered Nurse (RN) - Remote
Guidehealth —Chicago, IL
- $70,000 - $75,000 a year
- Full-time
- Remote
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Disability insurance
Utilization Review Nurse
Cobalt Benefits Group LLC —Dallas, TX
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Physical Health Registered Nurse (Remote)
Vaya Health —North Carolina
- $68,033.34 - $88,443.35 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- Computer literacy
9d
Utilization Management Physician Reviewer (Weekends)
Toney HealthCare Consulting, LLC —Remote
- $175 - $200 an hour
- Part-time
- Remote
- Medicine
- 3 years
- Senior level
- Health insurance
Quick Apply
Utilization Management Nurse Reviewer LPN (Work at Home for FL residents only)
Coastal Care Services, Inc. —Florida
- From $28 an hour
- Full-time
- Remote
- Microsoft Word
- Background check
- Spanish
- Disability insurance
- Health insurance
Quick Apply
7d
Medical Claim Reviewer (CGS, DMEC-B)
Broadway Ventures —Remote
- $31.25 an hour
- Remote
- Nursing
- RN License
- Customer service
- Disability insurance
- Dental insurance
Quick Apply
Nurse, Concurrent Review
HealthHelp - A WNS Company —Houston, TX
- $75,000 a year
- Weekends as needed
- Remote
- Nursing
- Microsoft Excel
- RN License
- AD&D insurance
- Paid holidays
Quick Apply
10d
Remote Quality Management RN
Upstream Search —Connecticut
- $51 an hour
- Temporary
- Remote
- Microsoft Word
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
11h
Nurse Care Mgr I (contract)
Elevance Health —Remote
- $27.26 - $52.19 an hour
- Contract
- Remote
- Nursing
- RN License
- Bachelor of Science
- Health savings account
- Disability insurance
7d
Utilization Management Nurse Consultant - Medical Review (Remote)
CVS Health —Jefferson City, MO
- $26.01 - $56.14 an hour
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
5d
Utilization Management Coordinator I
Community Health Plan of Washington —Seattle, WA
- $21.00 - $28.98 an hour
- Full-time
- Remote
- Research
- Office
- Analysis skills
- Paid jury duty
- Health savings account
Quick Apply
7d
Clinical Denials and Appeals Specialist
UASI —Remote
- Remote
- Microsoft Word
- Nursing
- RN License
- Disability insurance
- Health insurance
14d
Supervisor, Clinical Compliance (RN) - Remote
Guidehealth —Rockford, IL
- $85,000 - $91,000 a year
- Full-time
- Remote
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Paid parental leave
- Disability insurance
9d
Remote Delegating Registered Nurse Case Manager
The Arc Prince George's County —Remote
- $40.87 an hour
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Paid training
- 403(b) matching
Utilization Review Registered Nurse
Hines & Associates Inc —Rockford, IL
- $57,244 - $62,180 a year
- No weekends
- Remote
- Nursing
- Addiction Medicine
- RN License
- Paid holidays
- Disability insurance
Quick Apply

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nurse case reviewer (home based) jobs near

Second Level Reviewer I PRN Remote

AdventHealth Corporate -
Altamonte Springs, FL

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Job Details

PRN
$31.82 - $59.17 an hour

Benefits

Paid parental leave
Disability insurance
Health insurance
Dental insurance
Paid time off
Parental leave
Vision insurance
403(b)
Benefits from day one
Life insurance

Qualifications

Triage
Acute care facility experience
Medical treatment knowledge
Typing

Full Job Description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
Paid Time Off from Day One
403-B Retirement Plan
4 Weeks 100% Paid Parental Leave
Career Development
Whole Person Well-being Resources
Mental Health Resources and Support
Pet Benefits

Schedule:

PRN

Shift:

Day (United States of America)

Address:

900 HOPE WAY

City:

ALTAMONTE SPRINGS

State:

Florida

Postal Code:

32714

Job Description:

Reviews concurrent medical records for documentation compliance, including completeness and accuracy for severity of illness (SOI), risk of mortality (ROM), and quality. Completes accurate and timely record reviews to ensure the integrity of documentation compliance. Inputs data into CDI Software accurately and concisely, resulting in precise metrics obtained through the reconciliation process. Recognizes opportunities for documentation improvement using strong critical-thinking skills and sound judgment. Initiates and formulates CDI severity worksheets and clinically credible clarifications for inpatients, presenting opportunities for improved documentation compliance to physicians, nurse practitioners, and other clinical team members. Transcribes documentation clarifications as appropriate for SOI, ROM, PSI, HCCs, and HACs to ensure documentation compliance. Educates members of the patient-care team regarding documentation regulations and guidelines, including physicians, allied health practitioners, and nursing, with quarterly and annual compliance updates from Medicare. Communicates effectively and appropriately with physicians and other healthcare providers to ensure accurate and complete clinical documentation. Collaborates with HIM staff to resolve discrepancies with DRG assignments and other coding issues. Completes well-timed follow-up case reviews on all cases, prioritizing resolution of those with clinical documentation clarifications. Participates in department meetings, providing feedback on outstanding issues, presentations for educational opportunities, and addressing needs identified by CDI leaders. Assumes personal responsibility for professional growth, development, and continuing education to maintain a high level of proficiency. Performs other duties as assigned.Knowledge, Skills, and Abilities:

Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrates excellent physician relations. [Required]
Able to organize and present information clearly and concisely; excellent computer and keyboarding skills; ability to use multiple software programs simultaneously; high degree of prioritization skills. [Required]
Ability to learn/develop and fine-tune the skills necessary to perform optimally as a Clinical Documentation Specialist. [Required]
Dependable, self-motivated and pleasant. [Required]
Utilize and demonstrate excellent critical-thinking, problem-solving and deductive-reasoning skills. [Required]
Knowledge of pathophysiology, disease processes and treatments. [Required]
Strong ability to organize/triage work and manage multiple priorities at once. [Required]
Knowledge of clinical documentation requirements that identify clinical conditions or procedures. [Preferred]
Coding background. [Preferred]
Knowledge of quality guidelines. [Preferred]

Education:

Bachelor's of Nursing [Required]
Master's [Preferred]

Field of Study:

in healthcare related field

Work Experience:

5+ years acute care nursing experience with specific medical/surgical, Intensive Care, post-acute care unit, or Emergency Department experience. [Required]
3+ years of Clinical Documentation Specialist experience [Required]

Additional Information:

An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:- BSN and 3+ years of Clinical Documentation Specialist experience OR - 4+ years of Clinical Documentation Specialist experience OR - Less than 2 years of Clinical Documentation Integrity experience and 10 years of acute care nursing experience.

Licenses and Certifications:

Registered Nurse (RN) [Required] OR
Physician Assistant (PA) [Required] OR
Advanced Practice Registered Nurse (APRN) [Required] OR
Certified Clinical Documentation Specialist (CCDS) [Required]
Certified Billing and Coding Specialist (CBCS) [Preferred]
Certified Cardiac Device Specialist (CCDS) [Required]

Physical Requirements: (Please click the link below to view work requirements)

Physical Requirements -https://tinyurl.com/23km2677

Pay Range:

$31.82 - $59.17

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Apply Now

Refine Your Search

nurse case reviewer (home based) jobs

Second Level Reviewer I PRN Remote

Clinical Quality Reviewer - REMOTE - LCSW OR RN - US Citizen Required

Clinical Quality Reviewer - REMOTE - RN - US Citizen Required

Remote Home Health RN – Medical Claims Reviewer

DRG Nurse Reviewer Appeals and Hearings- Remote

Utilization Management Registered Nurse (RN) - Remote

Utilization Review Nurse

Physical Health Registered Nurse (Remote)

Utilization Management Physician Reviewer (Weekends)

Utilization Management Nurse Reviewer LPN (Work at Home for FL residents only)

Medical Claim Reviewer (CGS, DMEC-B)

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Remote Quality Management RN

Nurse Care Mgr I (contract)

Utilization Management Nurse Consultant - Medical Review (Remote)

Utilization Management Coordinator I

Clinical Denials and Appeals Specialist

Supervisor, Clinical Compliance (RN) - Remote

Remote Delegating Registered Nurse Case Manager

Utilization Review Registered Nurse

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