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RN Clinical Consultant in East Windsor, NJ at CBIZ

Date Posted: 11/27/2018

Job Snapshot

Job Description

With over 100 offices and nearly 5,000 associates in major metropolitan areas and suburban cities throughout the U.S. CBIZ (NYSE: CBZ) delivers top-level financial and employee business services to organizations of all sizes, as well as individual clients, by providing national-caliber expertise combined with highly personalized service delivered at the local level. CBIZ has been honored to be recognized as one of the Best & Brightest Companies to Work for in the Nation for 2016. The Best and Brightest Companies to Work For® competition identifies and honors organizations that display a commitment to excellence in their human resource practices and employee enrichment based on categories such as communication, work-life balance, employee education, diversity, recognition, retention and more. 

The RN Nurse Consultant is a professional who assists in performing hospital medical necessity reviews and defense audits for a national healthcare consulting company, in addition to other compliance activities.  Reviews cases in both retrospective and concurrent environments to assess adherence to admission / medical necessity criteria.  Provides analysis as to root causes for problematic situations and may at times be required to perform education for hospital clinical staff.  Should also have knowledge of billing and coding guidelines as well as hospital chargemaster operations.  Analyzes financial impact of changes in Medicare reimbursement. 

Essential Functions and Primary Duties:

  • Perform medical necessity reviews for acute care hospitals as well as for RAC defense audits in addition to other compliance activities
  • Review cases retrospectively in order to assess adherence to medical necessity admission criteria
  • Provide analysis as to root causes for problematic situations
  • Utilize knowledge of billing and coding guidelines, as well as hospital chargemaster operations
  • Conduct medical necessity reviews utilizing both electronic medical record and hard copy record
  • Develop and conduct education for hospital clinical staff based upon reviews conducted
  • Assist in design and development of new services and products
  • Additional duties as assigned

Preferred Qualifications: 

  • Proficiency in the application of InterQual Level of Care criteria is preferred
  • Knowledge of Milliman Care Guideline application, basic ICD-10 and CPT coding and CMS regulations preferred
  • Certification in Case Management or Utilization Management preferred

Qualifications Required:

  • Degreed and Licensed as a Registered Nurse (RN)
  • 3 years of nursing experience required
  • Demonstrated ability to communicate verbally and in writing throughout all levels of organization, both internally and externally
  • Proficient us of applicable technology
  • Able to travel as dictated by client
  • Ability to conduct the review of medical records for medical necessity
  • Knowledge of medical terminology, anatomy, physiology and concepts of disease
  • Knowledge of modern nursing principles, techniques and procedures for patient care

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CBIZ is an equal opportunity employer and reviews applications for employment without regard to the applicant's race, color, religion, national origin, ancestry, age, gender, marital status, military status, veteran status, sexual orientation, disability, or medical condition or any other reason prohibited by law. If you would like more information about your EEO rights as an applicant under the law, please visit these following pages EEO is the Law and EEO is the Law Supplement.

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