Performant Recovery, Inc. Medical Review Nurse II – Home Health: Job Overview, Location, and Employment Details

The job title for this position is Medical Review Nurse II – Home Health. This role is focused on performing medical claims audit reviews within the home health sector.

This position is located in Plantation, Florida. It is a full-time role that allows for remote work in a fast-paced and dynamic environment.

The hiring range for the Medical Review Nurse II – Home Health position is between $75,000 and $80,000. This compensation reflects the expertise and responsibilities associated with the role.

The primary responsibilities of the Medical Review Nurse II include performing medical claims audit reviews for both Government and Commercial Payers. This involves auditing claims for medically appropriate services provided in inpatient and outpatient settings while applying the appropriate medical review guidelines, policies, and rules.

The Medical Review Nurse II will be part of a multi-location team of experienced medical auditors and coders. This collaborative environment emphasizes teamwork in conducting retrospective and prepayment audits on medical claims.

In this role, the Medical Review Nurse II is required to document all findings by referencing the appropriate policies and rules. Additionally, they will generate letters that articulate audit findings and may need to support these findings during the appeals process if requested.

The Medical Review Nurse II contributes to improving medical policies by working in partnership with clients, CMD colleagues, and other contractors. They focus on enhancing provider education and system edits while keeping abreast of changes in medical practice, technology, and regulatory issues that may affect clients.

The Medical Review Nurse II assists with quality assurance functions and training team members. They also participate in establishing ideas that may improve audit workflows and work to minimize the number of appeals.