LPN- Retrospective Review Nurse
Location: Tampa Florida
Description: The CSI Companies is currently seeking to employ LPN- Retrospective Review Nurse right now, this occupation will be placed in Florida. More complete informations about this occupation opportunity please read the description below. The CSI Companies is currently seeking a Retrospective Review Nurse for a contract position in Tampa, FL.
The Retrospective Review Nurse:
Perf! orms case processing clinical evaluation and completion of ER PLP reconsiderations from receipt to adjudication
Utilizes clinical knowledge to evaluate and assess the clinical necessity of ER PLP reconsiderations
Key Duties and Responsibilities of the Retrospective Review Nurse :
Communicates with coordinators and Medical Directors the case disposition of ER PLP reconsiderations
Reviews medical records against PLP guidelines and recommends a case disposition
Applies clinical knowledge in the assessment evaluation and interpretation of clinical notes submitted by the provider
Evaluates the medical record so that patient age time of day severity of injury availability of medical resources etc are considered when adjudicating the PLP case
Documents the clinical aspects of the case and the reasoning for the determination outcome in numerous databases
When appropriate, seeks additional clinical advice and recommendations to properly adjudicate the! PLP case
Serves in all phases of the reconsideration proc! ess from preloading of cases case disposition and letter generation
Prepares cases for scanning and archiving
Verifies eligibility timeliness and record completeness of ER PLP cases and follows up with the provider as necessary
Electronically enters claim detail information in organization applications including Sidewinder and documents receipt disposition and other noteworthy aspects of the cases in the application
Assists in resolving provider issues through the use of organizational databases and reports communication with internal departments such as Claims and Appeals and contact communication with ER PLP clinical coordinators and Medical Directors
Participates in process development and testing of new process implementation
Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives
Participates in ad hoc projects that require clinical evaluation of medical records as directed ! by the Manager and or Director Identifies misuse of ER utilization and resources and communicates with Manager, Director, and Medical Director as needed Ensures timely processing and review of reconsiderations to meet departmental goals and state specific benchmarks for timeliness
Performs other duties as directed by the Manager and or Director
MINIMUM QUALIFICATIONS
1plus year of experience in general nursing
Required Licensed Practical Nurse LPN
Ability to identify basic problems and procedural irregularities collect data establish facts and draw valid conclusions
Intermediate Knowledge of medical terminology and or experience with CPT and ICD9 coding
Intermediate Ability to effectively present information and respond to questions from families members and providers
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Technology List technical skills associated with the ! job Technology develop solutions
- .
If you were eligible ! to this occupation, please email us your resume, with salary requirements and a resume to The CSI Companies.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Fri, 26 Jul 2013 06:26:49 GMT