Clinical RN Specialist – Active RN License, DRG Downgrade Experience

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🕒 June 11

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

Healthcare Insurance • SaaS • Artificial Intelligence

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Evaluate hospitalizations across the country utilizing medical knowledge and gaining expertise as an advisor. • Perform retrospective clinical case reviews and draft appeals focusing on establishing Medical Necessity by the payor or audit firm. • Provide expert guidance on patient care, medical documentation, and hospital protocols to optimize outcomes and compliance. • Serve as a resource for clinical education, process improvement, and interdisciplinary collaboration. • Construct and document succinct, fact-based clinical cases to support appeals utilizing appropriate criteria. • Collaborate with medical staff and case managers to facilitate appropriate patient classification and reimbursement processes. • Provide targeted training and education to clinical staff on DRG requirements and documentation standards. • Assist in developing and implementing policies to enhance clinical workflows and compliance. • Monitor ongoing patient care activities to ensure adherence to best practices across various clinical settings. • Maintain up-to-date knowledge of regulations, medical terminology, and industry best practices.

🎯 Requirements

• RN or MD degree with strong clinical knowledge - Active unrestricted clinical license in at least one state within the United States. • DRG downgrade experience is mandatory. • Certified in coding through either the AAPC (CPC/COC) or AHIMA (CCS/CCS-P) - Preferred • Minimum of 5 years recent acute-care hospital experience, preferred. • Minimum of 2 years Utilization Review / Case Management experience within the last 5 years. • Must have excellent written communication skills and be computer proficient. • Nursing background including hospital experience, nursing home care, teaching hospital exposure, pediatrics, or home health settings. • Strong understanding of medical documentation processes, coding practices, and medical records management. • Excellent knowledge of medical terminology, anatomy, physiology, and patient care procedures across diverse clinical disciplines. • Demonstrated ability to train and develop healthcare staff through adult education techniques and instructional design. • Familiarity with HIPAA compliance standards and confidentiality protocols in handling sensitive patient information. • Effective communication skills for interdisciplinary collaboration and delivering clear educational content.

🏖️ Benefits

• Competitive hourly salary • Medical/Dental/Vision Insurance • Equipment provided • 401k program • Accrued PTO • Paid Paternity & Maternity leave programs • 9 paid annual holidays • Life Insurance • Long term disability • Short term disability options • Tuition reimbursement and much more!