Registered Nurse - Clinical Review Nurse - Sacramento


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Registered Nurse - Clinical Review Nurse
Sacramento, California
 
The city of Sacramento is the capital of California, with a population of over 500,000. The broader Sacramento metro area is home to over 2.4 million residents. Sacramento is a major center for healthcare, with world-renowned UC Davis School of Medicine close by, making it an ideal location for talented healthcare professionals. Whether you prefer to work in a hospital, clinic, home care or senior housing setting - Sacramento job opportunities in healthcare are abundant.
 
Our client is looking for the next generation of healthcare leaders! If you are passionate about helping people get care, stay well, and build healthy communities, this is the place for you! We are searching for nursing professionals to work from home and ensure quality is maintained through the claims, payment, and billing process.
 
Registered Nurse - Clinical Review Nurse Responsibilities:
  • Responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare.
  • Apply clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care.
  • Accountable for adapting to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME.
  • Communicate clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions.
  • Comprehend medical policy and criteria to clearly articulate health information required
Registered Nurse - Clinical Review Nurse Qualifications:
  • Two (2) years’ clinical experience.
  • Background in Skilled Nursing Facilities, Hospice, Home Health and/or broad Part B preferred. Excellent communication skills.
  • Demonstrated prioritization, problem solving, and organization skills.
  • Strong computer skills, including Microsoft Office proficiency