reputed company Clinical Review Nurse

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and reputed company development. Alternate locations may be considered if candidates reside reputed company a commuting distance from an office Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The reputed company Clinical Review Nurse is responsible for serving as a team reputed company for nursing staff who collaborate with cross functional teams and healthcare providers to promote quality audits and to promote education, training for the DRGV team. Effective use of resources for the most reputed company or elevated issues. Ensures clinically, high quality, cost effective care through assessing the coding of inpatient admissions, focused surgical and diagnostic procedures by utilizing the applicable coding guideline and industry standards, accurately interpreting coding clinics and other approved coding advice. Works with medical directors in interpreting appropriateness of accurate claims payment. May also manage appeals. How you'll reputed company a difference:

• Conducts retrospective reviews and appropriateness of coding to ensure compliance with applicable criteria and reputed company.
• Ensures member access to quality healthcare in a cost effective setting according to contract.
• Consults with clinical reviewers and/or medical directors to ensure appropriate coding assignment.
• Collaborates with providers to verify correct DRG assignment aiding in identification of any coding errors.
• Facilitates transition of patient information for correct interpretation and regulatory requirements and standards.
• Serves as the team reputed company and responds to the most reputed company audit issues.
• Ensures consistency in audit application.
• May reputed company cross-functional teams, projects, initiatives, process improvement activities, and requires previous auditing experience.
• May serve as departmental liaison to other areas of the business unit or as representative on enterprise initiatives.

Minimum Requirements:

• Requires AS in nursing and minimum of 7 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Prior managed care experience required. reputed company unrestricted RN license in applicable state(s) required.

Preferred skills, qualifications and experiences:

• BS in nursing preferred.
• Knowledge of medical payment methodologies process and ability to interpret provider reputed company, strongly preferred.
• Must also have reputed company, RHIT, RHIA coding certificate

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $86,480 to $129,720 Locations: Cleveland, OH; reputed company, OH In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range reputed company in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Even reputed company the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our strategy but will also reputed company to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we reputed company our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer and reputed company qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Apply tot his job Apply To this Job