Requisition Number |
18-0488 |
Title |
Clinical Review Nurse |
City |
Jacksonville |
State |
FL |
Part Time |
No |
Description |
***Two positions available**
Summary: The Clinical Review Nurse will be responsible for performing medical necessity audits and other related duties as assigned.
Essential Duties and Responsibilities
• Performs medical necessity audit reviews using established criteria.
• Maintains documentation of clinical record reviews in data software.
• Assists in the preparation and presentation of clinical documentation monitoring/trending reports for review with physicians and leadership.
• Participates in completion of special projects, as assigned.
• Communicates with supervisor about assigned projects and audits.
• Maintains a courteous, professional, customer service focused demeanor at all times.
• Maintains a current working knowledge and understanding of billing, coding, and reimbursement regulations related to the wound care and hyperbaric services for both professional and facility billing.
• Maintains knowledge of regulatory changes and payer updates.
• Participate in Corporate training initiatives.
Competencies Required:
• To perform the job successfully, an individual should demonstrate the following competencies:
• Working knowledge of procedure and ICD-10 coding.
• Ability to review medical records using established criteria.
• Strong working knowledge of HBO and wound care coverage of services, preferred.
• Ability to manage multiple projects and tasks concurrently.
• Excellent oral & written communication skills.
• Strong interpersonal and communication skills and the ability to work effectively with all departments.
• Problem-solver with proven track record.
• Demonstrated knowledge and proficiency in using PC software to support activities, especially Microsoft Office.
• Ability to work with confidential material and maintain confidentiality along with sensitivity to employees and customer needs and data.
• Strong attention to detail.
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Requirements |
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
• Bachelor’s Degree in nursing from an accredited university or college preferred.
• Must maintain RN licensure.
• Minimum of 3 years related experience in nursing and/or clinical auditing. Experience in wound care services is a plus.
IND123
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