Virginia, 23947
Job description
Job Summary
The Sr. Nurse Reviewer (Medicare) is a pivotal role wherein the professional is responsible for evaluating and analyzing the quality of care provided to Medicare beneficiaries. This position requires an in-depth understanding of Medicare policies and the ability to conduct thorough reviews to ensure compliance and enhance patient outcomes.
Responsibilities
- Conduct comprehensive assessments of patient care documentation.
- Review and analyze clinical data to determine the appropriateness of services rendered to Medicare members.
- Collaborate with healthcare teams to promote quality improvement initiatives.
- Provide expert guidance on Medicare regulations and standards.
- Identify trends and issues related to quality of care and report findings.
- Assist in developing and implementing training programs for staff related to Medicare requirements.
Qualifications
- Registered Nurse (RN) with a valid state license.
- Minimum of 5 years of clinical experience, preferably in a Medicare setting.
- Strong knowledge of Medicare policies and healthcare regulations.
- Exceptional analytical and critical thinking skills.
- Effective communication and interpersonal abilities.
- Experience in quality assurance or utilization review is highly desirable.
Location
City, State Zip
Work Arrangement
Remote
Commence provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
