Drg Clinical Validation Nurse

Summary

Join MedReview, a leading authority in payment integrity solutions, as a clinically experienced registered nurse in our clinical validation department. This full-time, remote position offers flexibility to work from anywhere in the US, with virtual training and provided equipment. You will perform clinical record reviews, ensuring accurate medical coding, and write concise rationales supporting your findings. The role requires a minimum of two years' experience in inpatient coding, utilization management, or clinical validation, along with three years of clinical hospital experience. An active, unrestricted RN license is mandatory, and CCS or CIC certification is highly desired. MedReview offers excellent benefits, including healthcare, a 401(k) with employer match, generous paid time off, wellness programs, and learning and development opportunities.

Requirements

• Minimum of two years’ experience in inpatient coding, utilization management, and/or clinical validation
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Minimum of 3 years clinical experience in a hospital setting with experience including but not limited to reading history and physical examination reports, interpreting laboratory and ancillary test results, and discharge summary reports
• Active, unrestricted RN license
• Ability to use common computer applications, such as Word
• Understanding of anatomy, physiology, and diagnostic and surgical procedures
• Working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
• The ability to accurately interpret a medical record
• The ability to work in an environment with productivity expectations
• High speed internet (100 Mbps per person recommended) with secured WIFI
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information
• Must be able to sit and use a computer keyboard for extended periods of time

Responsibilities

• Perform clinical record review, utilizing clinical expertise, judgement, guidelines, and policies to ensure the accuracy of medical coding
• Write clear, accurate and concise rationales in support of findings

Preferred Qualifications

CCS or CIC certification is highly desired

Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
• Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional