State Licensed Medical Review Nurse
Job Summary
Working remotely, the full-time salaried State Licensed Medical Review Nurse will perform Skilled Nursing Facility (SNF) medical claims audit reviews, conducting retrospective and prepayment audits for Government and Commercial Payers.
Key Responsibilities:
- Auditing claims for medically appropriate services in skilled nursing facilities while applying relevant medical review guidelines
- Documenting findings and generating letters that articulate audit results
- Collaborating with the audit team to identify vulnerabilities and improve medical policies and provider education
Required Qualifications:
- Active unrestricted RN license in good standing
- Minimum of five (5) years of diversified nursing experience in inpatient or outpatient settings
- At least one (1) year of experience with MDS/RAI processes
- One (1) or more years' experience performing medical records review
- Expertise in ICD-9/ICD-10 coding guidelines as they relate to the MDS RAI process
Complete Job Description
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