RN Utilization Review Specialist

VieMed; Lafayette (LA); In loco; USD 65.000 - 85.000; Tempo pieno

Descrizione del lavoro

VieMed in Lafayette, LA seeks a full-time, on-site RN to perform clinical reviews of patient medical records, evaluate documentation for prescribed therapies, and determine coverage suitability.

You will review orders, notes, tests, and other documentation; advise on readiness and missing information, and ensure compliance with Medicare/Medicaid/payer requirements and HIPAA. Normal hours are Monday–Friday, 8:00 a.m. to 5:00 p.m.

Competenze

• Current, active RN license in good standing.
• Clinical nursing experience with ability to review medical records and apply nursing judgment.
• Ability to read/interpret diagnoses, physician orders, progress notes and other clinical records.
• Working knowledge of medical terminology and respiratory/DME therapies.
• Understanding of Medicare/Medicaid/commercial payer documentation requirements.
• Strong attention to detail and professional written/verbal communication.

Mansioni

• Conduct clinical reviews of patient records to evaluate documentation supports prescribed therapies, equipment and coverage.
• Review physician orders, progress notes, histories and tests to assess referral relevance.
• Identify missing or unclear documentation and communicate needs.
• Apply nursing knowledge to evaluate diagnoses, treatment history and medical-necessity indicators.
• Provide recommendations on referral readiness and required documentation.
• Evaluate documentation against payer criteria prior to submission for reimbursement.
• Maintain compliance with regulations, payer requirements and VieMed procedures.
• Document findings and status in the designated system.
• Escalate complex questions to intake leadership as needed.
• Perform other duties and projects as assigned.

Formazione

RN license

Strumenti

EMR systems

Microsoft Office

Descrizione del lavoro

VieMed in Lafayette, LA seeks a full-time, on-site RN to perform clinical reviews of patient medical records, evaluate documentation for prescribed therapies, and determine coverage suitability.

You will review orders, notes, tests, and other documentation; advise on readiness and missing information, and ensure compliance with Medicare/Medicaid/payer requirements and HIPAA. Normal hours are Monday–Friday, 8:00 a.m. to 5:00 p.m.