Nurse Educator – Review Coordinator

This is a fully remote position, open to applicants in Nevada.

📋 Description

• The primary responsibility of the Nurse Educator/Review Coordinator is to enhance provider education concerning the claim reviews conducted under Task Order 3 for the BFCC-QIO contract.

• The education delivered will be based on the review outcomes and may encompass the application of Medicare policy, ICD-10-CM/PCS coding standards, DRG assignment, medical necessity, or other pertinent claim review subjects.

• Collaborate with staff, management, and the Medical Director to pinpoint billing issues that could benefit from provider education.

• Offer recommendations related to problem identification and suggested solutions.

• Stay updated on the latest evidence regarding new practices and quality indicators through learning activities, in-services, and information sharing.

• Adhere to policies, procedures, and standards.

• Support management in evaluating staff competencies and training needs.

• Assist management with inter-rater reliability or other quality assurance processes.

• Conduct educational sessions with providers on CMS-mandated medical record documentation for claim reviews.

• Aid in the preparation of final claim review provider letters.

• Encourage initiatives to enhance provider compliance.

• Act as a liaison between the provider and the QIO.

• Execute desktop medical reviews.

• Interpret and apply review criteria relevant to specific roles.

• Communicate with and support physician reviewers by summarizing case details, preparing case inquiries, and helping resolve issues that require physician input.

• Ensure the dissemination of current information essential for the effective implementation of contract expectations.

• Provide feedback to Managers to assist in evaluating staff performance.

• Maintain records and data related to job tasks and responsibilities.

• Safeguard the confidentiality of patient information by complying with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).

⛳️ Requirements

• Completion of an accredited nursing program and current licensure as a Registered Nurse (RN) or accreditation as a Health Information Management professional (RHIA, RHIT, CCS) with necessary coding experience, skills, and knowledge.

• Preference for individuals with a degree in a healthcare-related discipline who have a professional clinical background, particularly with Medicare QIO experience in claim reviews or in conducting medical reviews in support of MAC or RAC appeals, pre- and post-pay claims reviews, and utilization reviews.

• Candidates must be detail-oriented and possess clinical knowledge relevant to the area in which provider education will be delivered.

• Capability to organize and manage multiple concurrent tasks within a team setting.

• Ability to comprehend and follow complex written and verbal instructions.

• Proficiency in data collection, distinguishing relevant information, and exercising sound judgment.

• Competence in problem-solving while maintaining objectivity.

• Strong computer keyboard skills and the ability to write clearly in English.

• Ability to work independently with minimal supervision.

🏝️ Benefits

• [Detail specific benefits here, if provided]

• [Add any additional benefits as needed]