Perry County, Ohio

Overview

The Nurse Reviewer will perform clinical reviews to assess the appropriateness of care based on medical record documentation. This includes documenting findings, determining approvals, and assisting in training new Nurse Reviewers.

Overview

The Utilization Review Nurse will conduct reviews for medical necessity and appropriateness of services, ensuring compliance with clinical criteria and policies. This includes engaging with providers, documenting findings, and assisting in training new nurses.

Overview

The DRG Nurse Reviewer Appeals and Hearings coordinates and performs all appeal-related duties, including analyzing and responding to provider appeals and preparing case files for hearings. The role also involves participating in hearings and assisting in training new reviewers.

Overview

The Clinical DRG Auditor performs clinical and coding validation reviews of medical records to ensure the accuracy of DRG assignments and diagnosis coding. They also provide mentorship and training to team members while maintaining compliance with regulatory and official coding guidelines.