Job Description

Details

Client Name
Metroplus Health Plan

Job Type
Travel

Offering
Nursing

Profession
RN

Specialty
Case Manager

Job ID
33023125

Job Title
RN - Chart Review (000298)

Weekly Pay
$2565.75


Shift Details

Shift
Day - 7.5x5 - 09AM

Scheduled Hours
37


Job Order Details

Start Date
11/03/2025

End Date
12/27/2025

Duration
8 Week(s)


Job Description
Job Title: Chart Review Nurse
Profession: RN
Specialty: Clinical Review
Duration: 9 months
Shift: Hybrid (9 AM - 5 PM)
Hours per Shift: 40
Experience: Minimum 2 years
License: Client RN License
Certifications: Primary Source Verification
Must-Have: Clinical knowledge in reviewing medical charts


Description:
Use clinical knowledge to review medical charts for accuracy and sequencing of diagnoses.
Validate clinical and coding assessments based on consultation reports.
Assess history and physical reports, operative reports, progress reports, and discharge reports, including complex cases.
Review medical records and healthcare claims for accuracy and compliance with regulations, standards, policies, and procedures.
Conduct audits of high-risk claims and billing patterns to ensure adherence to healthcare regulations.
Collaborate with team members to evaluate suspected cases of fraudulent activities.
Create detailed reports with medical review findings, including research and recommendations.
Validate whether audited claims should be denied or recouped and determine required mitigation strategies.
Participate in provider calls to discuss findings and rationale of medical reviews.
Present findings to leadership and stakeholders to facilitate investigations.
Assist in preparing documentation for audits, compliance, and regulatory inquiries.
Maintain thorough documentation of investigations and communications with providers.
Stay updated on changes to coding guidelines and fraud detection methods.
Complete special projects and audits as required.


Client Details

Address
50 Water Street

City
New York City

State
NY

Zip Code
10004


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Job Tags

Weekly pay, Shift work,

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