Performing CDI QA reviews, both concurrent, prebill and retrospective. Must meet the following requirements for consideration: Registered Nurse. Expert in reviewing all medical records. Ability to ensure complete and accurate diagnosis capture and coding.
Applicants must meet the following qualifications: 5 years working with continuous quality improvement processes. 5 years interpreting regulations and assessing plan impact. 5 years in Leadership. Bachelor's Degree in Nursing or Public health-related field.
An insurance company is seeking a Telecommute Clinical Quality Registered Nurse in the Pittsburgh Area. Core Responsibilities Include: Preparing reports and records on work function activities and projects. Reviewing and analyzing reports, records, and medical documents/charts.
Must be a Registered Nurse or Licensed Clinical Social Worker. 5 years of progressive leadership responsibility. Successful management experience. Thorough and solid knowledge of health care. Experience with Accountable Care Organizations, Medicaid, Medicare and Commercial populations.