Hospice RN Reviewer

Under limited supervision, complete internal clinical record reviews to assess hospice's compliance with its Corporate Compliance Program, policies and procedures, and controls to ensure all clinical operations conform to established hospice standards, hospice policy, state and federal regulations and industry compliance trends. Monitors and trends data from both internal and external sources to analyze and report significant trends requiring intervention to assist clinical operations in improving overall performance in patient outcomes and reimbursement.

Education :

Bachelor's degree from an accredited School of Nursing required; Master's degree in Nursing preferred

Experience :

Hospice experience and / or hospice auditing experience preferred. 5 years of diversified, progressive experience in acute care and / or other settings within the continuum; Hospice Case Management and utilization management experience preferred. Centers for Medicare and Medicaid Services (CMS), Managed Care Organization (MCO), and / or other payer experience strongly preferred.

Skills :

• Advanced skills in clinical assessment of the patient / family
• Familiarity with all aspects of and criteria regarding the health care continuum
• Familiarity with the hospice Conditions of Participation, specifically related to Quality Assessment Performance Improvement (QAPI)
• Familiar with hospice billing requirements, specifically the Conditions for Coverage / Payment
• Knowledge of all third-party health care reimbursement systems and claim denial processes
• Knowledge of the CMS Conditions of Participation for long-term care facilities (e.g., nursing facilities and skilled nursing facilities)
• Knowledge of State and Federal Utilization requirements and denial / appeal regulations
• Skill in data analysis and reporting
• Skill in using computer software programs and personal productivity applications
• Advanced skill in oral and written communication
• Advanced skill in critical thinking
• Ability to resolve complex problems
• Ability to remain calm under pressure and intense time constraints

Licensures, Certifications

Physical Requirements

Working Conditions

Conditions of Employment

Principal Duties and Responsibilities

Pay Range

$71,326.17 - $122,384.79

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

COVID-19 Vaccination

All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.