Job Description

TravelNurseNetwork is working with Infojini Healthcare to find a qualified Case Manager RN in New York City, New York, 10004!Pay Information$2,236 per weekAbout The PositionID: 55531747 Shift: Hybrid 9-5BA in Nursing Required•AAPC Coding certification - Certified Professional Coder (CPC), Description: Use clinical knowledge to review medical charts for accuracy and sequencing of diagnosis to those assigned from Consultation reports, History and Physical reports, Operative reports, Progress reports, Discharge reports including complex cases. This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier your expected pay range may vary and/or include certain benefits like: Medical, Dental, Vision, 401K [include any compulsory benefits such as commissions, incentive bonuses, etc. if applicable]. Pay range: (USD)36.57 hrly -(USD)49.70 hrly Schedule 9-5BA in Nursing Required AAPC Coding certification - Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) - RequiredWe need a clinician to review medical records to validate clinical and coding assessmentsMedical coding Review medical records and healthcare claims to determine the accuracy and compliance of billed codes with appropriate regulations, standards, policies, and procedures. Conduct audits of high-risk claims and billing patterns to ensure adherence to healthcare regulation and MetroPlusHealth policy and detect potential FWA. Collaborate with other SIU team members to evaluate suspected cases of fraudulent activities, such as over-utilization of services, upcoding, and billing for non-medically necessary services. Create detailed reports with medical review findings that include research, rationale, sources and corrective action recommendations to the SIU Department. The reports will also validate whether audited claims should be denied, recouped and if other mitigation strategies are required. Participate as needed on provider calls to discuss findings and rationale of medical review. Present findings to leadership and other stakeholders to facilitate all FWA proceedings. Assist in preparing documentation for audits, recoupments, compliance/legal reviews and regulatory inquiries. Maintain thorough documentation of investigations, including clinical findings, coding discrepancies and all communication with healthcare providers and investigators. Stay updated to changes to coding guidelines, healthcare regulations, and fraud detection methods to ensure compliance and effective investigations. Completes special projects and audits as required.Skills: Two years experienceEducation: Required: New York State RN License, Primary Source Verification,Job Category: MetroPlus Non-Clinical Guaranteed Hours: 40.00 Contract Weeks:6127974317TNNPLATJob RequirementsRequired for OnboardingCompetency ExamCore Mandatory ExamSelf Assessment (Skills Checklist)About Infojini HealthcareAt Infojini Healthcare, We tell it like it is. Infojini Healthcare is one of the fastest-growing healthcare staffing firms. Consecutively ranked among the INC 5000 fastest-growing companies from the past five years, Infojini is dedicated to serving excellence in a breadth of staffing services. Our global footprints are spread over 26+ locations including the USA, Canada, and India. Working at the intersection of people, process, and technology, our recruiters constantly provide progressive and sustainable staffing solutions to challenges faced by our clients. Being in the industry since 2006 and serving an array of healthcare facilities, we understand the key talent needs of the healthcare industry and its associated verticals. Full-time, part-time, temp-to-hire, contractual, or urgent hiring, whatever is your requirement, you can trust Infojini to deliver the specific skills and expertise you need. At Infojini Healthcare, we understand the importance of quality patient care. With our comprehensive allied professionals and nurse staffing services, we provide you access to a qualified network of healthcare professionals including allied and nursing staff. Each professional is pre-screened and matched to your specific qualifications, for assignments ranging from three weeks up to several months. Trained in the latest technologies, our temporary allied professionals offer you a broad spectrum of specialties in therapy, imaging, laboratory, and pharmacy. Our extensive network of qualified travel nurses is available on a variety of assignment lengths customizable to your needs – per diem (1-n weeks), traditional travel (13-26 weeks), and short-term travel (4-8 weeks). We know every healthcare facility is incomplete without its backend teams. To support this, we place proficient and trained EMR & EHR professionals after thorough skill evaluation, licensing verification. These professionals combine their healthcare expertise and IT skills to strengthen your admin and clerical needs. Healthcare roles we specialize in, Registered NursesAllied Healthcare ProfessionalHealthcare IT SpecialistsClerical & Admin Staff

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