Registered Nurse Clinical Readmission Manager

Job Summary

To enhance healthcare outcomes, the full-time Remote Registered Nurse Clinical Readmission Manager will conduct prepayment and post-payment clinical reviews of inpatient admissions and related readmissions, ensuring compliance with organizational and regulatory guidelines.

Key responsibilities

• Conduct clinical reviews of inpatient admissions and related readmissions within 30 days of prior discharge, assessing clinical relationships and potential consolidations
• Apply established guidelines and criteria consistently when evaluating cases and prepare clear, objective documentation of findings
• Collaborate with internal teams to address complex cases and support the dispute and appeal processes through thorough documentation

Required qualifications

• Current, active, and unrestricted RN license in at least one U.S. state
• Five or more years of experience in clinical nursing, healthcare audit, or related environments with a focus on inpatient hospital readmissions
• Strong knowledge of inpatient clinical care, disease processes, and discharge planning
• Experience in reviewing medical records and synthesizing clinical information from multiple sources
• Ability to prepare clear and defensible clinical rationales and documentation for review findings