Review documentation for medical necessity per guidelines outlined in the Social Security Act 1862(a)(1).Utilize the applicable Medicare policies (i.e., Local Coverage Determinations, National Coverage Determinations, Internet-Only Manual (IOM) citations, inpatient tools, etc.) to ensure the services comply with all Medicare regulations and documentation requirements.Review medical record documentation within CMS timeliness parameters (i.e., 20 days from receipt of the medical record for pre-payment reviews and 50 days from receipt of the medical record for post payment reviews).Complete a projected number of clinical review hours while meeting timeliness and accuracy standards and completing documentation of clinical decisions for remittance.Perform clinical reviews of Medicare Part A and Part B claims for Medical Review, Redeterminations/Appeals (Appeals), and Prior Authorization requests (collectively, the “Services”) in accordance with CMS (Centers for Medicare & Medicaid Services) requirements.Take advantage of our competitive, comprehensive benefits package including medical, dental, vision, life, short-term disability, long-term disability & 401(k).Maintain work-life balance with guaranteed 8-hour shifts.Maximize family time with no weekend, Holiday, or on-call requirements.We recognize the foundation of our firm is our people and we continue to rise above our competition by hiring the best.Īvosys is seeking a Remote Registered Nurse - Medical Review Specialist to work remotely to review Medicare clains. ![]() Founded in 1998, Avosys provides services nationwide to Federal, Commercial, Local and State clients. Staff nurses follow the guidance of the charge nurse and perform their assigned tasks under their supervision.Overview:Avosys is a growing integrator of professional, technological and management solutions services. They also supervise and evaluate the performance of the nursing staff, providing feedback and mentoring as necessary. ![]() Staff nurses, while contributing to patient care decisions, typically follow the directives provided by charge nurses and the healthcare team.ĭelegation and Supervision: Charge nurses are responsible for delegating tasks to staff nurses and ensuring that assignments are distributed equitably based on skill levels and patient needs. They make critical decisions related to patient assignments, prioritize care needs, and address any emergent situations. Leadership and Decision-Making: Charge nurses serve as leaders within their units, providing guidance and support to the nursing staff. ![]() Staff nurses primarily focus on providing direct patient care, following the care plans established by the healthcare team. They are responsible for managing the nursing unit, ensuring adequate staffing levels, coordinating patient admissions and discharges, and addressing any issues or concerns that arise during their shift. Scope of Responsibilities: Charge nurses have additional administrative duties beyond direct patient care. While both charge nurses and staff nurses are registered nurses, there are distinct differences in their roles and responsibilities.
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