PRIVATE – Members Only
Job Requirements
The Diverse Staffing Clinical Review Nurse I at this client location performs the following responsibilities:
Responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare.
Applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care.
Adapts to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME.
Articulates clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions.
Education
Requires AS in nursing and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license required.
BS in nursing preferred.
Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.
Preferred Qualifications:
(Training provided) Two (2) years’ clinical experience; Knowledge of Medicare a plus; Home Health/ Fraud detection a plus; Ability to comprehend medical policy and criteria to clearly articulate health information required; Strong computer skills, including Microsoft Office proficiency; Experience working with direct patient care; UM Review experience; Medicare Part B experience; Medical Review experience
US Citizen who has lived in the U.S. three out of the last five years
Ability to pass an in-depth criminal background check
Benefits: Insurance offered
Pay Range is between $35-42/ per hour depending on their location. – All candidates must be Vaccinated.
Diverse Staffing is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or other protected status. Diverse Staffing is committed to providing jobs for veterans transitioning to civilian life.