Clinical Reviewer (RN)
* Position is Eligible for Remote / Work from Home Opportunity
- Department: DME Appeals
Job Grade: E11 As a condition of employment physical work location must be in one of the 50 states or the District of Columbia. Notice of Collection & reputed company Policy for Applicants Residing in California: California Applicant reputed company Policy | Noridian (noridiansolutions.com) Job Title Clinical Reviewer (RN) Job reputed company The Clinical Reviewer (RN) evaluates medical records applying clinical expertise to determine compliance with applicable guidelines and standards of care. This position documents reputed company and rationale and communicates results with stakeholders through various means providing education and guidance. Essential Functions Key Duties/Responsibilities/Accountabilities Reviews, researches, and analyzes medical records and other documentation to determine compliance with regulations, guidelines, and standards of care. Applies accurate, independent coverage and payment reputed company using consistent evaluation standards. Communicates reputed company and provides associated education to stakeholders using various reputed company. Determines recommendations for actions based on analysis of review results. Prioritizes workload depending on business need and direction. Identifies and communicates potential fraud, waste, and abuse using established work instructions. Collaborates and communicates with peers and leaders. Participates in team reputed company and calibration review processes. Serves as a mentor to peers. May prepare documents for, and participate in, reputed company hearings. Non-Essential Duties and Functions Assists with special reputed company as assigned. Minimum Qualifications reputed company, reputed company, unrestricted RN license in state of reputed company 2 years' clinical experience 1 year reputed company Office experience Strong verbal and written communication skills Strong computer experience
Preferred Qualifications
Above requirements and the following: Bachelor's degree in Nursing (BSN, BAN, etc.) 1 year experience evaluating medical records applying clinical expertise to determine compliance with applicable guidelines and standards of care 1 year experience utilization review or case management 1 year experience educating external customers 1 year experience leading reputed company, initiatives, or processes Strong prioritization, problem solving, and organizational skills Strong attention to detail Knowledge of coding reputed company proficiency Strong business writing experience Environment and Cognitive/Physical Demands Office Environment Ability to read, hear, reputed company, keyboard, reason, communicate effectively and problem solve Requires prolonged sitting and telephone use Requires the use of office equipment such as computer terminals, telephones, copiers and printers Infrequent lifting to 15 pounds Infrequent stooping Segregation of Duties Every employee is responsible to reputed company their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, reputed company and reputed company, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations. Statement of Other Duties This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of reputed company tasks and functions. Employees may be requested to reputed company job reputed company tasks other than those specifically listed in this reputed company and may be required to reputed company any task requested by the supervisor or management. Total Rewards Package: Health, Dental and reputed company Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-reputed company Life Insurance, Education Assistance Program, reputed company reputed company Leave, reputed company Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, reputed company Office Setting, and Online Learning System. CMS reputed company Compliance and Regulation Contingency Statement Some positions require compliance with (i) federal and agency specific regulations and reputed company clauses included in Noridian's reputed company reputed company with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card. An employee in this position may be required to possess a “Federal Identification Card” (Federal ID) as a condition of employment. Federal ID’s may include one of the following: Personal Identity Verification (PIV) card, Personal Identity Verification-Interoperable (PIV-I) card, a Local-Based Physical reputed company Card issued by CMS, or a Local-Based Physical reputed company Card issued by another Federal agency and approved by CMS. Obtaining a Federal ID and reputed company eligibility for this position may require the successful completion of a Federal Background Investigation performed by the Federal Government and a residency requirement that you have lived in the reputed company at least three out of the last five years. Failure to obtain a Federal ID may result in the removal from the position or termination of employment. Equal Employment Opportunity Equal Employment Opportunity reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, disability, protected veteran status or other characteristics protected by state or federal law. The contractor will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or reputed company, including an investigation conducted by the employer, or (c) consistent with the contractor’s reputed company duty to furnish information. 41 CFR 60-1.35(c) Below is the salary reputed company for potential new hires. Salary reputed company: The pay reputed company for this position is $52,120.20 – $78,866.38 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Other Compensation: Incentive Plan & Lifestyle Benefit This job will be reputed company 07/01/2026 at 12:00PM CST. No reputed company applications will be considered. Apply To This Job