Readmission Review Nurse

SALARY: $35 - $50/hr based on experience

DRG Compliance is a division of FairCode providing DRG Validation services to health insurance plans.

The ReadmissionReview Nursewillcollaborate with supervisor and the designated client(s)’ medical director toidentify, evaluate, and present evidence of inpatient admissions andsubsequentreadmissions as being potentially preventablein accordance withCMS definition and DRG Compliance’s criteria set.

Responsibilities

• Communicate timely with supervisor and client regarding review findings.
• Communicate initial findings for purposes of DRG calculations of recommended changes resulting from combining the stays for coding / payment purposes.
• Prepare written report for positive findings and communication comments on tracking sheet for negative findings.
• Monitor tracking sheet for outstanding medical records and keep supervisor informed at least every 14 days of outstanding medical records.
• Maintain current documentation of processes. Participate in other activities as assigned.

Requirements

• An RN with a minimum of 3-5 years experience in Utilization Management in a health plan or hospital setting.
• Case Management or discharge planning experience would be a plus but not required.
• Must be able to write reports to provide relevant medical record documentation and criteria-based findings.
• Excellent written and verbal communication skills, andtheability to work independently with minimal supervision.
• Working knowledge of Microsoftproducts such as Microsoft Word, Excel, and Outlook; however, MAC documents compatible for Microsoft conversion can be utilized.

Remote Position: Enjoy the convenience of working from home or anywhere in the U.S. Work-Life Balance: We encourage a healthy balance between your professional and personal life.

Supportive Team: Join a team of dedicated professionals who value innovation, collaboration, and excellence.