Observation Clinical Analyst - RN

City/State

Work Shift

Overview:

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

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.