RN Field Review (7080)

Company Name:
Carewise Health
This job reports to the Manager, Clinical Field Review.
Relocation is not provided and travel is not required.
This is a Full-Time position, working 1st Shift.
Number of Openings for this position: 1
Carewise Health helps organizations improve the personal health of employees and control healthcare costs. Our industry-leading health and wellness programs help members build the skills they need to achieve and sustain optimum health. Medical Bill Review ensures that health plans and self-insured employers are billed accurately for the care their members receive. Headquartered in Louisville, Ky., Carewise Health employs approximately 500 registered nurses, health coaches, clinicians, medical directors and other committed professionals.
Job Skills/Requirements
The Field Review Nurse is responsible for performing onsite reviews for inpatient nursing facility admission, verifying medical necessity for nursing facility care and assuring that facilities are in compliance with Medicaid regulations. In addition, the field review nurse is responsible for performing onsite reviews and monitoring compliance and reimbursement for Home Health Agencies for various programs provided through the Department for Medicaid Services.
Essential Functions:
Perform RUG reviews in accordance with established guidelines.
Review for PASRR compliance on initial review and then bi-annually during level of care
Perform ancillary reviews for long-term care residents in accordance with established timeframes.
Perform home health, home and community based waiver, early periodic screening, diagnosis, and treatment (EPSDT), Michelle P Waiver, Adult Day Health Care, and Model II Waiver reviews.
Other duties as assigned.
Unrestricted active Kentucky Registered Nursing License.
Associate degree or higher education in Nursing required.
Three to five years experience direct patient care/clinical required.
Two to Five years direct experience with long-term care and/or home health preferred.
Knowledge of principles and procedures of Utilization Review as well as URAC standards preferred.
Excellent interpersonal skills; oral and written communication, listening, problem solving, decision making, stress management, diplomacy, etc.
Proficient in the use of Microsoft Word, Excel and Outlook.
Must have a significant degree of comfort with the use of a lap-top.
Must be proficient in typing.
Demonstrated leadership skills.
Ability to travel in the Louisville/Frankfort area in order to complete the audits. Must reside in Jefferson, Franklin or Shelby county.
Education Requirements
Associate''s degree or higher in nursing
Certification Requirements
Unrestricted Active KY RN License
Additional Information/Benefits
Carewise Health provides a generous benefits package including:
Medical Insurance
Dental Insurance
Life Insurance
Vision Insurance
Paid Vacation
Paid Holidays
Paid Sick Days
Short Term Disability
Long Term Disability
401K Plan With Company Match
Tuition Reimbursement
Employee Assistance Program
All benefits are effective on the 29th day of employment with the exception of tuition reimbursement and STD/LTD, which is effective after 90 days of employment.
Attention Staffing Agencies: This position is not open for agency submittals. Any candidate submitted without HR approval will be considered an applicant of Carewise Health, not the agency. All Agency Candidates must first be submitted to HR.
If you are interested in applying for employment with Carewise Health and need special assistance or an accommodation to apply for a posted position, call (option 1) to leave a message with your requested accommodation.
EO/AA Employer: Minority/Female/Disability/Veteran
Location: Frankfort, Kentucky
Division: Carewise Health
Per Diem: No
Position: RN Field Review (7080)

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