Hospice Utilization Review Nurse - REMOTE - RN Required
Cantex Health Care Centers LLC

Job Info

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Job Description
Title: Hospice Utilization Review Nurse - REMOTE - RN Required

Facility: Corporate Office

Zip: 75001

Diversity, Equity, and Inclusion are at the heart of Cantex. We are committed to a culture that respects our differences and values the contributions of all people.

Job Summary:

TheHospiceUtilizationReview Nurseis responsible for conducting concurrent and retrospective chart review for clinical, financial and resource utilization information. To capture the clinical severity for the level of service rendered to hospice patients to ensure quality, cost-effective care, and compliance with regulatory agencies and third-party care payors. Please note that this position will work remotely.

Essential Functions:

• Complete ADR (Additional Documentation Request) and payer claim denial management following company standards.
• Review medical records prepared in response to active medical review by Medicare, Medicaid and other insurers/payers.
• Review clinician HIS data and develop POCs to ensure accuracy and comprehensive adherence to CMS guidelines and best practices
• Participate in weekly IDG meetings and provide sound clinical recommendations to hospice clinicians and leadership
• Contribute to timeliness and appropriateness of all appeals according to rules outlined by payer and state and federal guidelines.
• Responsible for receiving facility inquiries related to claims and maintaining all documents in question.
• Develop clinical position statements in support of claims under medical review based on skilled services rendered and available medical record evidence in support of the hospice services billed.
• Participate in the claims appeals process, maintain electronic claims tracking systems, and create reports.
• Deliver sound consulting services to facilities, ensuring professional and timely communications.
• Consistently demonstrate sound judgment in the assessment/review of records
• Stay abreast of clinical and regulatory changes; in accordance with current standards of practice and payer guidelines.
• Conduct clinical documentation audits to determine coding accuracy based on coding guidelines and standards of care.
• Create reports to summarize audit quality review findings with corrective action plan recommendations as applicable.
• Assist with the collection of clinical/rehabilitation notes, records, and/or detailed bills, as assigned.
• Compiles and verifies data; ensures timely follow up with facilities regarding missing documentation or upcoming due dates.
• Provide backup support for data entry and clerical tasks, as needed.
• Other special projects and duties, as assigned.

Job Requirements
Qualifications:

• Must be a Registered Nurse in the state of Texas.
• Must have a minimum of 2 years’ experience in Hospice setting.
• Working knowledge of HIS and ICD-10 coding.
• ICD-10 coding certification preferred.
• Broad-based understanding of Medicare Hospice regulations and requirements.
• Broad-based understanding of standards of practice for clinical documentation.
• Proficiency in computer usage including database and spreadsheet analysis, presentation programs, word processing and internet searching. Experience with Home Care Home Base required
• Strong written, oral and interpersonal communication skills.

We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.

This job has expired.