Registered Nurse, Reviewer
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Registered Nurse reviewing Medicare records and preparing physician-review cases for Avar Consulting’s policy research programs. Supporting audits, quality assurance, and Medicare FFS/MA documentation.
Responsibilities:
- Review medical records
- Prepare cases for physician review
- Perform desktop non-physician review activities and audit functions
- Accurately and timely abstract review-related data and information using appropriate review tools
- Communicate with and support physician reviewers by summarizing case facts and issues requiring physician input
- Conduct mandatory case review and quality assurance activities stipulated by contracts
- Maintain required timeliness and accuracy throughout the review process
- Meet production goals
- Prepare reports and other documentation with attention to Medicare FFS and Medicare Advantage plan policies
Requirements:
- Graduation from an accredited school of nursing
- Active professional licensure
- Minimum of 2–4 years of experience in clinical decision making relative to Medicare patients
- Dedicated home office and reliable internet access for secure viewing of protected health information
- General knowledge of a PC-based computer system
- Intermediate knowledge of various MS Office programs and ability to learn additional software applications
- Only US citizens and permanent residents will be considered
- Experience with Medicare Appeals processing / BFCC Medicare Quality Improvement Organization (QIO) core functions is desirable
- Healthcare-related degree and professional clinical background with Medicare QIO experience may also qualify
Benefits:
- Medical, dental, and vision insurance; base plan employee premiums 100% company paid
- Employer-paid life and disability insurance, including STD and LTD
- Employee Assistance Plan and employee discounts
- 11 federal holidays
- PTO accrual with carryover
- 401(k) plan with company match
- Flexible Spending Accounts: medical, dependent, and transit
- Tuition reimbursement and training assistance
Similar Jobs
Triage Nurse, RN – Part Time
Remote part-time RN providing early-morning telephone triage for CareXM’s hospice and home health partners. Assessing patients, giving care instructions, coordinating care, and documenting in EHRs.
Oncology Nurse Educator
Oncology Nurse Educator delivering clinical education for AstraZeneca’s lung and GI cancer medicines. Engaging healthcare providers across the Northwest and supporting patient care strategies.
Licensed Practical Nurse
Licensed Practical/Vocational Nurse delivering in-home care for Caring Hand Home Health Solutions. Providing treatment, education, documentation, and coordination for patients recovering at home.
Registered Nurse
Per-diem Registered Nurse supporting Caring Hand Home Health Solutions’ in-home patient recovery services. Reviewing OASIS assessments, ICD-10 coding, compliance, and clinical documentation quality.
Registered Nurse, Triage Call Agent
Registered Nurse triaging and educating patients by phone for Intermountain Health’s clinical communication center. Assessing needs, documenting calls, and directing patients to appropriate care.
Utilization Review Nurse – Weekends
Utilization Review RN managing evidence-based admission, stay, and discharge reviews at UAMS academic medical center. Coordinating payer communication and interdisciplinary discharge planning.
Registered Nurse Education Coordinator
Registered Nurse Education Coordinator developing FirstChoice nursing education programs for Trinity Health. Designing curricula, assessing competencies, and coordinating staff development across Iowa.
Patient Flow Nurse
Registered Nurse coordinating scheduling, triage, lab follow-up, and provider collaboration for Teladoc Health’s virtual care services across Canada.
Registered Nurse, RN
Registered Nurse overseeing care plans and caregiver supervision for non-medical home care clients. Supporting seniors and individuals with special needs to maintain independence and quality of life.
Bi-Lingual RN Care Team, LPN
Bilingual remote nurse delivering app-based chronic-condition care at Salvo Health. Supporting behavior change, patient engagement, and personalized health education for gut and metabolic conditions.
Utilization Management Registered Nurse
Utilization Management RN coordinating medical-necessity determinations for Humana, a U.S. healthcare and insurance company. Supporting post-acute care across skilled nursing, home health, and durable medical equipment services.
Registered Nurse – Triage and Transitions Team
Registered Nurse care manager providing remote triage, care planning, and transitions support for Intermountain Health patients. Coordinating providers, resources, and evidence-based interventions across healthcare settings.
Nurse Trainer/Educator
Casual nurse trainer delivering clinical skills education for Healthcare Australia’s healthcare workforce. Conducting practical and theoretical assessments across Western Australia.
STAR Flight Nurse
Flight Nurse providing critical care during air-medical transports for PHI Health, a United States air ambulance provider. Performing emergency assessment, treatment, stabilization, and transport documentation.
Utilization Management Nurse
Utilization Management Nurse supporting IntusCare’s PACE healthcare technology ecosystem for vulnerable seniors. Reviewing admissions, authorizations, claims, transitions, and provider appeals for compliant, value-based care.
Triage Nurse
Registered Nurse providing virtual triage, clinical advice, and referrals for Amplar Health’s Australian healthcare services. Assessing consumer needs remotely while working a rotating after-hours roster.
Patient Support Nurse
Patient Support Nurse guiding pharmaceutical patients through medication education, insurance access, and therapy adherence. Delivering telephonic clinical support for Valeris, a life sciences commercialization partner.
Registered Nurse – Adult Inpatient Care
Registered Nurse reviewing inpatient documentation and AI-generated clinical outputs for 24-MAG LLC’s healthcare AI evaluation projects. Annotating nursing data and assessing clinical safety, accuracy, and quality.
Licensed Practical Nurse – Admission / Intake Coordinator
SSM Health intake nurse reviewing hospice, home health, and infusion referrals. Coordinating admissions, eligibility, patient transitions, and multidisciplinary care planning.
Clinical Triage Nurse, RN – M-TH-Fri-Sat 9:30a to 8p
Remote Clinical Triage Nurse assessing patient symptoms and test results for HarmonyCares’ in-home primary care services. Coordinating urgent care guidance, provider communication, and patient follow-up.