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Clinical Services Specialist RN
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Job Description
- Req#: 25-180
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely from home with flexible hours
- Supportive and collaborative work environment
- Engage in meaningful work that impacts patient care and compliance
- Comprehensive benefits package including health, dental, and vision insurance
- Competitive pay commensurate with experience
What to Expect (Job Responsibilities):
- Analyze patient records to determine the legitimacy and necessity of medical services in compliance with reimbursement policies
- Serve as a resource for non-clinical staff regarding clinical-related questions or issues
- Write accurate review summaries and submit them within the designated timeframe
- Maintain files and prepare monthly reports as required
- Communicate effectively with internal and external clients regarding utilization management requirements
What is Required (Qualifications):
- Diploma or Associate's degree in nursing, licensed as a Registered Nurse in the state of Arkansas
- Minimum of three (3) years of clinical nursing experience
- Intermediate computer skills, including proficiency in Excel, Word, Access, PowerPoint, and Outlook
- Strong oral and written communication skills, with exceptional business English and spelling
- Ability to maintain confidentiality and adhere to HIPAA compliance
How to Stand Out (Preferred Qualifications):
- Bachelor's degree in nursing
- Experience in Quality Assurance / Utilization Review and/or coding
- Knowledge of ICD 9/ICD 10 coding
- Familiarity with health information technology (HIT) and electronic health records (EHR)
- Previous experience in project management or quality improvement processes
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