RN Utilization Review Specialist

Sleep Management, LLC dba Viemed; Lafayette (LA); In loco; USD 54.000 - 76.000; Tempo pieno

Descrizione del lavoro

Sleep Management, LLC dba Viemed is offering a full-time Utilization Review Coordinator position from 8:00 a.m. to 5:00 p.m. in an office setting.

The RN will review patient records to determine coverage for therapies and equipment, ensure documentation supports recommendations, and verify payer criteria prior to submission. Strong attention to detail and experience with EMR systems are required.

Competenze

• Active RN license in good standing.
• Experience reviewing medical records and physician documentation.
• Ability to apply nursing judgement to documentation and coverage requirements.
• Familiarity with Medicare/Medicaid and payer documentation requirements.

Mansioni

• Conduct clinical reviews of patient records to evaluate documentation supports therapies and equipment.
• Review orders, progress notes, diagnostic information, and hospital records for referral relevance.
• Identify missing or unclear documentation and communicate deficiencies.
• Apply nursing knowledge to evaluate diagnoses, treatment history, and medical-necessity indicators.
• Provide recommendations on referral readiness and next steps based on chart reviews.
• Evaluate documentation against payer criteria before submission for reimbursement.
• Maintain compliance with regulations and VieMed procedures.
• Accurately document findings and referral status in the system.
• Escalate complex questions to Intake Manager or leadership as needed.
• Perform other duties as assigned.

Conoscenze

RN license

Clinical nursing

Medical records review

Documentation interpretation

Medicare/Medicaid knowledge

PHI handling

EMR systems

Microsoft Office

Strumenti

EMR software

Outlook

Word

Excel

Descrizione del lavoro

Sleep Management, LLC dba Viemed is offering a full-time Utilization Review Coordinator position from 8:00 a.m. to 5:00 p.m. in an office setting.

The RN will review patient records to determine coverage for therapies and equipment, ensure documentation supports recommendations, and verify payer criteria prior to submission. Strong attention to detail and experience with EMR systems are required.