Conducts thorough analysis encompassing clinical review and assessment of patient records focusing on the documentation of the clinical condition and the care provided. Ensures that level of patient services provided is accurately and completely documented. Develops, communicates and implements solutions/programs to address problem areas identified through quality studies or claim denials working directly with physicians and other health care professionals.
Education - Bachelor's Degree or equivalent in Nursing
Experience - 5 years of experience typically gained through skills/knowledge/abilities in a clinical role,Experience in any one or more of the following areas: insurance, utilization review, case management, coding and/or clinical documentation review
Licenses - Licensed as a Registered Nurse (RN) in the State of Michigan, or Mid-Level Provider licensed in the State of Michigan, or similar level of clinical training and experience
Education - Bachelor's Degree or equivalent in Nursing (for CCAP department); health care or other related field (for Denials department)
Position Requisition #: 49994