Nursing and Care Specialist
2 weeks ago
Job Title: Clinical Reviewer for External Audits
Job Description:
We are seeking a highly skilled Clinical Reviewer for External Audits to join our team at Intermountain Healthcare. As a key member of our utilization review team, you will be responsible for reviewing governmental contractors' response letters and medical records to determine the viability of appeals.
About the Role:
The ideal candidate will have a strong understanding of federal regulations, law, and relevant CMS policies, as well as excellent clinical judgment and communication skills. You will research and apply these regulations to support appeals, communicate with stakeholders regarding missing or insufficient medical documentation, and ensure timely completion of data entry in audit databases.
Responsibilities:
- Review and Analysis: Conduct thorough reviews of governmental contractors' response letters and medical records to determine the viability of appeals.
- Communication: Communicate effectively with stakeholders regarding missing or insufficient medical documentation.
- Research and Application: Research and apply federal regulations, law, and relevant CMS policies to support appeals.
- Data Entry: Ensure timely completion of data entry in audit databases.
Requirements:
- Bachelor's Degree: Bachelor of Science in Nursing (BSN) preferred.
- Licensure: Current licensure as a registered nurse in state of practice.
- Experience: Three (3) years of experience in utilization review or care management, hospital insurance billing, third-party claim audits, or auditing in a healthcare setting.
Compensation and Benefits:
This role offers an estimated salary of $54.53 per hour, making it an attractive opportunity for nursing professionals looking to advance their careers. We also provide a comprehensive benefits package, including health, dental, and vision insurance, 401(k) matching, and paid time off.
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