Clinical Claim Review RN
: Job Details :

Review and interpret clinical documentation (e.g., anesthesia records, operative reports, progress notes, therapy notes, discharge plans) Make determinations per relevant protocols and clinical judgement Use available resources to interpret coding accuracy Apply clinical and departmental guidelines (e.g., CMS, MCG, medical and reimbursement policies) Interpret and apply applicable Federal and State mandates Summarize clinical information and provide medical recommendations to medical directors Adhere to relevant quality audit standards in performing reviews, making determinations and documentation Apply critical thinking skills and professional nurse judgement to solve moderately complex problems Works with minimal guidance; seeks guidance on only the most complex tasks Acts as a resource for others with less experience Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as...RN, Clinical, Medical Director, Health, Healthcare