Travel Nurse RN - Case Manager - $2,565 per week in New York City, NY - Cynet Health : Job Details

Job Title: Chart Review Nurse Profession: RN Specialty: Clinical Review Duration: 9 months Shift: Hybrid (9 AM - 5 PM) Hours per Shift: 40 Experience: Minimum 2 years License: Client RN License Certifications: Primary Source Verification Must-Have: Clinical knowledge in reviewing medical charts Description: Use clinical knowledge to review medical charts for accuracy and sequencing of diagnoses. Validate clinical and coding assessments based on consultation reports. Assess history and physical reports, operative reports, progress reports, and discharge reports, including complex cases. Review medical records and healthcare claims for accuracy and compliance with regulations, standards, policies, and procedures. Conduct audits of high-risk claims and billing patterns to ensure adherence to healthcare regulations. Collaborate with team members to evaluate suspected cases of fraudulent activities. Create detailed reports with medical review findings, including research and recommendations. Validate whether audited claims should be denied or recouped and determine required mitigation strategies. Participate in provider calls to discuss findings and rationale of medical reviews. Present findings to leadership and stakeholders to facilitate investigations. Assist in preparing documentation for audits, compliance, and regulatory inquiries. Maintain thorough documentation of investigations and communications with providers. Stay updated on changes to coding guidelines and fraud detection methods. Complete special projects and audits as required.