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Readmission Review Nurse

FairCode Associates, LLC

Role overview

Qualifications

  • An RN with a minimum of 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
  • Working knowledge of Microsoft products such as Microsoft Word, Excel, and Outlook

Responsibilities

  • Communicate timely with supervisor and client regarding review findings
  • Prepare written report for positive findings and communication comments on tracking sheet for negative findings
  • Monitor tracking sheet for outstanding medical records and keep supervisor informed at least every 14 days
  • Maintain current documentation of processes and participate in other activities as assigned

Key facts

Hard skills

Utilization Management

Other skills

  • Report Writing
  • Microsoft Word
  • Microsoft Excel
  • Microsoft Outlook
  • Communication

About the company

FairCode Associates, LLC logo

FairCode Associates, LLC

Company details

Links

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Job description

This is a remote position.

ROLE: Readmission Review Nurse 

LOCATION: Remote, no travel required

TERMS: Part-time, non-exempt

SALARY: $35 - $50/hr based on experience

DRG Compliance is a division of FairCode providing DRG Validation services to health insurance plans. 


The Readmission Review Nurse will collaborate with supervisor and the designated client(s)’ medical director to identify, evaluate, and present      evidence of inpatient admissions and subsequent readmissions as being potentially preventable in accordance with CMS definition and DRG Compliance’s criteria set. 
​

Responsibilities:

  • Communicate timely with supervisor and client regarding review findings. 
  • Communicate initial findings for purposes of DRG calculations of recommended changes resulting from combining the stays for coding / payment purposes.  
  • Prepare written report for positive findings and communication comments on tracking sheet for negative findings.  
  • Monitor tracking sheet for outstanding medical records and keep supervisor informed at least every 14 days of outstanding medical records.    
  • Maintain current documentation of processes. Participate in other activities as assigned. 



Requirements

  • An RN with a minimum of 3-5 years experience in Utilization Management in a health plan or hospital setting.
  • Case Management or discharge planning experience would be a plus but not required.
  • Must be able to write reports to provide relevant medical record documentation and criteria-based findings. 
  • Excellent written and verbal communication skills, and the ability to work independently with minimal supervision.
  • Working knowledge of Microsoft products such as Microsoft Word, Excel, and Outlook; however, MAC documents compatible for Microsoft conversion can be utilized.   


Benefits


Remote Position: Enjoy the convenience of working from home or anywhere in the U.S.
Work-Life Balance: We encourage a healthy balance between your professional and personal life.
Supportive Team: Join a team of dedicated professionals who value innovation, collaboration, and excellence.

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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