Registered Nurse - Clinical Review Nurse - Detroit
On Time Talent Solutions
Detroit, MI, us
4d ago

Registered Nurse - Clinical Review Nurse

Detroit, MI

Our client is seeking 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
  • For more information please call 763-231-1402 or simply apply!

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