Utilization Review RN – Clinical Chart Auditor

Sleep Management, LLC dba Viemed; Lafayette (LA); In loco; USD 55.000 - 75.000; Tempo pieno

Descrizione del lavoro

Sleep Management, LLC dba Viemed is seeking an Utilization Review Coordinator to review patient records for therapy coverage and medical necessity.

In this full-time role, you will evaluate physician orders, progress notes, and related documentation against Medicare, Medicaid and commercial payer criteria, and document findings in the EMR. Monday–Friday, 8:00 a.m. to 5:00 p.m., in Lafayette, LA.

Experience as an RN with strong attention to detail and communication skills is essential.

Competenze

• Current, active Registered Nurse (RN) license in good standing.
• Clinical nursing experience with ability to review medical records and apply nursing judgement.
• Ability to read and interpret diagnoses and medical documentation.
• Understanding of Medicare/Medicaid and payer documentation requirements.
• Strong attention to detail and clear communication.
• Proficiency with electronic medical records and related databases and Microsoft Office applications.

Mansioni

• Conduct clinical reviews of patient records to evaluate documentation supports therapies and coverage.
• Review orders, progress notes, histories, and other clinical information relevant to referrals.
• Identify missing or unclear documentation and communicate deficiencies clearly.
• Apply nursing knowledge to evaluate diagnoses, treatment history, and payer criteria.
• Provide recommendations on referral readiness and next steps based on chart-review findings.
• Evaluate documentation against payer criteria prior to submission for reimbursement.
• Document findings and referral status in the designated system.
• Escalate complex questions to Intake Manager or leadership as needed.
• Perform other responsibilities and projects as assigned.

Conoscenze

RN license

Clinical experience

Nursing judgement

EMR systems

Microsoft Office

Communication skills

RN licensure

Strumenti

Microsoft Excel

Outlook

Descrizione del lavoro

Sleep Management, LLC dba Viemed is seeking an Utilization Review Coordinator to review patient records for therapy coverage and medical necessity.

In this full-time role, you will evaluate physician orders, progress notes, and related documentation against Medicare, Medicaid and commercial payer criteria, and document findings in the EMR. Monday–Friday, 8:00 a.m. to 5:00 p.m., in Lafayette, LA.

Experience as an RN with strong attention to detail and communication skills is essential.