Readmission Review Nurse
$72,800–$104,000 year
RemoteUnited States
Job Summary
Collaborate with supervisors and medical directors to identify and evaluate potentially preventable inpatient readmissions according to CMS definitions and DRG Compliance criteria. Communicate findings regarding DRG calculations and recommended coding changes, then prepare written reports for positive results while tracking negative findings on designated sheets. Monitor outstanding medical records on the tracking sheet and update supervisors at least every 14 days, maintaining current documentation of all processes. This remote, part-time role supports DRG validation services for health insurance plans, requiring an RN with 3-5 years of Utilization Management experience and strong written communication skills.
Required Qualifications
- RN
- 3-5 years experience in Utilization Management in a health plan or hospital setting
- Must be able to write reports to provide relevant medical record documentation and criteria-based findings
- Excellent written and verbal communication skills
- Ability to work independently with minimal supervision
- Working knowledge of Microsoft products such as Microsoft Word, Excel, and Outlook
Desired Qualifications
- Case Management experience
- Discharge planning experience
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.