Registered Nurse Clinical Reviewer

Job Summary

Working remotely in a full-time capacity, the Registered Nurse Clinical Reviewer will conduct comprehensive clinical chart reviews to ensure accurate documentation of patient care and diagnoses, collaborating with various healthcare professionals to uphold compliance with coding guidelines and regulatory standards.

Key responsibilities

• Perform comprehensive secondary reviews of clinical documentation to identify gaps and ensure compliance with CMS and other regulatory standards
• Collaborate with Coders, Quality Department, and Providers to ensure documentation accurately reflects the severity of illness and risk of mortality
• Document and track results of secondary reviews, providing education and feedback to enhance understanding of clinical documentation integrity goals

Required qualifications

• University Degree with 4-6 years of relevant experience; experience may substitute for formal education
• Current licensure as a Registered Nurse, MD, or equivalent, or certification as a Medical Coder through AHIMA with CCS, RHIA, or RHIT credentials
• 4-6 years of experience in clinical documentation, CDI second level review, or inpatient coding quality review
• Strong understanding of disease processes, clinical indications, and provider documentation requirements
• Must maintain credentials while employed