Clinical Reviewer (RN)

Noridian Healthcare Solutions, LLC•Fargo, ND

4d•$52,120 - $78,866•Remote

About The Position

The Clinical Reviewer (RN) evaluates medical records applying clinical expertise to determine compliance with applicable guidelines and standards of care. This position documents decisions and rationale and communicates results with stakeholders through various means providing education and guidance.

Requirements

Current, active, unrestricted RN license in state of practice
2 years' clinical experience
1 year Microsoft Office experience
Strong verbal and written communication skills
Strong computer experience

Nice To Haves

Bachelor's degree in Nursing (BSN, BAN, etc.)
1 year experience evaluating medical records applying clinical expertise to determine compliance with applicable guidelines and standards of care
1 year experience utilization review or case management
1 year experience educating external customers
1 year experience leading projects, initiatives, or processes
Strong prioritization, problem solving, and organizational skills
Strong attention to detail
Knowledge of coding
Microsoft proficiency
Strong business writing experience

Responsibilities

Reviews, researches, and analyzes medical records and other documentation to determine compliance with regulations, guidelines, and standards of care.
Applies accurate, independent coverage and payment decisions using consistent evaluation standards.
Communicates decisions and provides associated education to stakeholders using various methods.
Determines recommendations for actions based on analysis of review results.
Prioritizes workload depending on business need and direction.
Identifies and communicates potential fraud, waste, and abuse using established work instructions.
Collaborates and communicates with peers and leaders.
Participates in team quality and calibration review processes.
Serves as a mentor to peers.
May prepare documents for, and participate in, legal hearings.
Assists with special projects as assigned.