[Hiring] Peer to Peer Nurse Author RN @R1 RCM

Role Description

As our Peer-to-Peer Nurse Author, you will help our clients by reviewing cases for which the authorization has been denied and evaluating if the proper documentation was available to support the admission status, procedure, and care setting that was requested. Every day you will advise our clients regarding the appropriateness of the request based on available documentation to ensure proper billing and authorization level; thereby increasing clean claims submission and reducing accounts receivable days. To thrive in this role, you must have strong clinical knowledge across multiple areas and be capable of working independently with a high level of performance in a fast-paced production environment.

• Write clinical consultations evaluating the authorization requested, documentation support or lack of support for that authorization, evidence-based criteria for that support, and complex clinical evaluation of the request as a whole.
• Evaluate and interpret multiple types of hospital documentation as it relates to the requested authorization.
• Provide feedback regarding actionable root cause analysis of the specific case to the client hospitals regarding submitted cases.
• Serve as a clinical resource to medical and case management staff by providing analysis of documentation issues and opportunities.
• Provide written analysis of the case and perform case reviews across multiple specialties.

Qualifications

• Active RN license
• 1+ year of hospital-based utilization management experience a plus
• 3+ years of recent acute, hospital-based clinical experience in a medical/surgical unit, emergency department, and/or ICU

Requirements

• For this US-based position, the base pay range is $65,478.00 - $96,885.29 per year. Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
• This job is eligible to participate in our annual bonus plan at a target of 10.00%.

Benefits

• Competitive benefits package.