Lehigh Valley Health Network·Pennsylvania
The Clinical Record Reviewer manages and supports quality improvement by reviewing patient records to ensure accurate documentation and medical necessity. They consult with providers and operations to facilitate corrective actions and maintain compliance with clinical criteria.
Imagine a career at one of the nation's most advanced health networks.
Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.
LVHN has been ranked among the "Best Hospitals" by U.S.
News & World Report for 23 consecutive years.
We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region.
Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety.
These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.
Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network. LV HOME CARE AND HOSPICE CLINICAL RECORD REVIEWER - FULL-TIME DAYS (REMOTE)
Summary Manages and supports quality and performance improvement by assisting staff to implement strategies that identify, prioritize, measure, and improve key clinical processes and outcomes. Reviews patient records to determine the complete, accurate, and timely documentation of all conditions that support home health/hospice care and treatment of the patient.
Job Duties Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care Consults with providers, management, and operations to ensure consistency within the application of clinical criteria Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements Maintains current knowledge of clinical indicators and compliance requirements Manages tools to collect outcome data and provides regular feedback to individuals, managers, and leaders Provides concurrent medical record review to assess documentation compliance. Facilitates recommended interventions Reviews deficiencies in documentation with involved staff and facilitates corrective action Participates in the ongoing development and implementation of an established performance improvement plan Reviews orders for data entry, completeness, and appropriateness for admission to home health/hospice services Promotes, obtains, and reviews appropriate documentation for any home health/hospice specific quality data
Associate’s Degree in Nursing. 2 years Experience as a Registered Nurse. Ability to work cross functionally across remote teams. Demonstrates a working knowledge of Medicare guidelines for hospice coverage. Demonstrated track record of continuous quality improvement. Proficient in prioritizing work and delegating where indicated. HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical Specialty Coding and Compliance Within 1 Year or HCS-O - Home Care Clinical Spec-OASIS - Board of Medical Specialty Coding and Compliance Within 1 Year or COS-C - Certificate OASIS Specialist-Clinical - OASIS Certificate & Competency Board Within 1 Year and RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire
Bachelor’s Degree in Nursing. 2 years Hospice experience and 1 year Hospice documentation experience or 2 years Home Care experience and 1 year Home Health OASIS documentation or 1 year ICD-9/ICD-10 coding experience HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical Specialty Coding and Compliance Upon Hire or HCS-O - Home Care Clinical Spec-OASIS - Board of Medical Specialty Coding and Compliance Upon Hire or COS-C - Certificate OASIS Specialist-Clinical - OASIS Certificate & Competency Board Upon Hire
Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.
Lehigh Valley Health Network is an equal opportunity employer.
In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law.
All personnel actions and programs will adhere to this policy.
Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities. https://youtu.be/GD67a9hIXUY Lehigh Valley Health Network does not accept unsolicited agency resumes.
Agencies should not forward resumes to our job aliases, our employees or any other organization location.
Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.
Work Shift: Day Shift Address: 1200 S Cedar Crest Blvd Primary Location: REMOTE IN PENNSYLVANIA Position Type: Remote Union: Not Applicable Work Schedule: Monday- Friday 8 hours Remote RN Department: 1004-09187 Health Center Central Business Office - CC
Candidates must hold an Associate’s Degree in Nursing and a valid Pennsylvania RN license with at least 2 years of nursing experience. Proficiency in Medicare guidelines and relevant clinical certifications such as HCS-D, HCS-O, or COS-C is required or must be obtained within one year.
Market context
Pennsylvania nursing roles are typically in steady demand across hospitals, outpatient settings, and long-term care, especially for RNs with current state licensure and BLS certification. These positions are competitive because employers often prefer candidates with a BSN and recent medical-surgical experience, and this platform’s AI-summarized requirements and benefits help you review the original posting faster. Before applying, confirm your Pennsylvania RN license, BLS status, and whether your experience matches the unit’s preferred background.
