Clinical Record Reviewer, RN

Job not on LinkedIn

🔥 13 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Lehigh Valley Health Network

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

Lehigh Valley Health Network is a comprehensive healthcare system that is now part of Jefferson Health, one of the top 15 not-for-profit health systems in the United States. It offers a wide range of medical services, including primary care, urgent care, and specialized institutes like the Lehigh Valley Topper Cancer Institute and the Lehigh Valley Heart and Vascular Institute. LVHN provides extensive care solutions, including video visits, second opinions, and a network of doctors and clinicians in numerous locations. It emphasizes education through residencies and fellowships and prioritizes patient-centric services such as lab testing and women's health care. The network also focuses on innovation, offering clinical trials and advanced therapies like CAR-T Cell Therapy.

📋 Description

• Manages and supports quality and performance improvement by assisting staff to implement strategies that identify, prioritize, measure, and improve key clinical processes and outcomes • Reviews patient records to determine the complete, accurate, and timely documentation of all conditions that support home health/hospice care and treatment of the patient • Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care • Consults with providers, management, and operations to ensure consistency within the application of clinical criteria • Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements • Maintains current knowledge of clinical indicators and compliance requirements • Manages tools to collect outcome data and provides regular feedback to individuals, managers, and leaders • Provides concurrent medical record review to assess documentation compliance • Facilitates recommended interventions • Reviews deficiencies in documentation with involved staff and facilitates corrective action • Participates in the ongoing development and implementation of an established performance improvement plan • Reviews orders for data entry, completeness, and appropriateness for admission to home health/hospice services • Promotes, obtains, and reviews appropriate documentation for any home health/hospice specific quality data

🎯 Requirements

• Associate’s Degree in Nursing • 2 years Experience as a Registered Nurse • Ability to work cross functionally across remote teams • Demonstrates a working knowledge of Medicare guidelines for hospice coverage • Demonstrated track record of continuous quality improvement • Proficient in prioritizing work and delegating where indicated • HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical Specialty Coding and Compliance Within 1 Year • HCS-O - Home Care Clinical Spec-OASIS - Board of Medical Specialty Coding and Compliance Within 1 Year • COS-C - Certificate OASIS Specialist-Clinical - OASIS Certificate & Competency Board Within 1 Year • RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire

🏖️ Benefits

• Health care experience • Commitment to teamwork, compassion, and technology • Opportunity to do great work