Remote RN: Clinical Readmission Auditor

Devoted Health Services, Inc

Waltham (MA)

On-site

USD 73,000 - 125,000

Full time

6 days ago

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Benefits offered by this job

Health, dental, vision plan

Generous paid time off

Mobile/internet stipend

Stock options

401K program

Parental leave

Job summary

Devoted Health is seeking a Clinical Readmission Manager to lead clinical reviews of inpatient hospital admissions and related readmissions within 30 days of prior discharge. You will review claims and medical records to determine clinical relation and preventable readmissions, and produce defensible determinations with supporting documentation.

Required RN licensure and 5+ years in clinical nursing or healthcare audit.

Qualifications

Registered Nurse with active RN license in at least one US state.
Five+ years in clinical nursing, hospital care, or healthcare audit.
Inpatient readmission review experience is preferred.
Ability to review medical records and apply clinical criteria.

Responsibilities

Conduct prepayment and postpayment clinical reviews of inpatient admissions and related readmissions within 30 days.
Apply organizational and regulatory guidelines consistently.
Document determinations with clear clinical rationales.
Prepare dispute responses and appeal documentation.
Collaborate with Payment Integrity and QA teams on complex cases.
Participate in calibration, peer reviews and quality assurance.
Maintain accurate records in review systems while protecting patient information.
Identify trends and opportunities to improve readmission review processes.