RN Clinical Utilization Review Specialist

VieMed Healthcare; Lafayette (LA); In loco; USD 60.000 - 80.000; Tempo pieno

Descrizione del lavoro

VieMed Healthcare seeks a Registered Nurse reviewer in Lafayette, LA to conduct clinical chart reviews for therapies, equipment, and payer documentation. You will assess medical records, determine completeness, and communicate deficiencies to providers and intake leadership.

Solid nursing judgment and accuracy are essential as you ensure compliance with Medicare/Medicaid and commercial payer requirements, while maintaining timely documentation in the EMR system.

Competenze

• Current, active RN license in good standing.
• Clinical nursing experience with ability to review medical records and apply professional nursing judgement.
• Ability to read and interpret diagnoses, physician orders, progress notes, and other clinical records.
• Working knowledge of medical terminology and respiratory and DME therapies.
• Understanding Medicare, Medicaid, and commercial payer documentation requirements.
• Strong attention to detail with the ability to identify gaps and communicate clearly.
• Effective written and verbal communication with physicians, insurers, teams.
• Ability to manage multiple chart reviews and meet turnaround expectations.
• Proficiency with EMR, patient/referral databases, and MS Office.
• Demonstrated professionalism, initiative, and consistency in productivity.
• Availability Monday–Friday with potential weekends/overtime as needed.

Mansioni

• Conduct clinical reviews of patient medical records and referral documentation to evaluate documentation supports therapies, equipment, and coverage requirements.
• Review physician orders, progress notes, histories and physicals, diagnostics, test results, and hospital records relevant to referrals.
• Identify missing or unclear documentation and communicate deficiencies.
• Apply nursing knowledge to evaluate diagnoses, symptoms, and medical-necessity indicators.
• Provide recommendations on referral readiness and next steps based on chart reviews.
• Evaluate documentation against Medicare, Medicaid and commercial payer criteria prior to submission for reimbursement.
• Maintain compliance with governmental regulations and VieMed procedures.
• Accurately document findings, deficiencies, recommendations, and status in the system.
• Escalate complex questions to Intake Manager or leadership as needed.
• Perform other responsibilities and projects as assigned.

Conoscenze

RN license

Clinical nursing experience

Nursing judgement

Attention to detail

Verbal & written communication

Time management

Independent work

Team collaboration

Strumenti

EMR systems

Microsoft Office (Outlook, Word, Excel)

Descrizione del lavoro

VieMed Healthcare seeks a Registered Nurse reviewer in Lafayette, LA to conduct clinical chart reviews for therapies, equipment, and payer documentation. You will assess medical records, determine completeness, and communicate deficiencies to providers and intake leadership.

Solid nursing judgment and accuracy are essential as you ensure compliance with Medicare/Medicaid and commercial payer requirements, while maintaining timely documentation in the EMR system.