Offer summary

Qualifications:

Registered Nursing Diploma required., Valid RN license is mandatory., Three years of Registered Nursing experience is necessary., Specialty certification required within one year for Integrated Care Management departments..

Key responsibilities:

Review physician orders for medical necessity and appropriateness based on Payor guidelines.

Facilitate comprehensive care coordination services and quality outcomes for patients.

Develop and implement comprehensive care plans based on patient needs assessment.

Collaborate with healthcare teams and manage care transitions.

Job description

City/State

Norfolk, VA

Work Shift

First (Days)

Overview:

Sentara Health is hiring an Observation Clinical Analyst, Registered Nurse for the Health Information Management Department.

This is a Full-time, REMOTE, 40 hours per week, 8 hours per day, Day shift position.

Review of physician orders for medical necessity, appropriateness based on Payor guidelines, and applying charges for Observation hours.

Responsible and accountable for the provision and facilitation of comprehensive care coordination services and quality outcomes for patients across the continuum. Promotes effective utilization and monitoring of health services, collaborates and communicates with the healthcare team and patient/caregiver to manage care and transitions. Develops and/or implements a comprehensive care plan based on assessment and evaluation of patient/caregiver needs. Functions in one of the following practice settings: Acute Care, Service Lines, Ambulatory/Community-based, Home Health, and Long Term Care.

Education

Registered Nursing Diploma

Certification/Licensure

Valid RN license
For Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM, CMAC or CGMT-BC). For other service lines, certification based on specialty area required within one year of eligibility.

Experience

Three years Registered Nursing experience required.
Epic EMR experience preferred.

Keywords: Talroo-Health Plan, Talroo-Nursing, Monster, LinkedIn, billing, medical necessity, audit, observation hours, payor guidelines, CCM, ACM, CCCTM, CMAC, Epic, charges, chart review, revenue cycle, patient billing, utilization review

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans

• Adoption, Fertility and Surrogacy Reimbursement up to $10,000

• Paid Time Off and Sick Leave

• Paid Parental & Family Caregiver Leave

• Emergency Backup Care

• Long-Term, Short-Term Disability, and Critical Illness plans

• Life Insurance

• 401k/403B with Employer Match

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education

• Student Debt Pay Down – $10,000

• Reimbursement for certifications and free access to complete CEUs and professional development

•Pet Insurance
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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