The Field Review Nurse is responsible for performing onsite reviews for inpatient nursing facility admission, verifying medical necessity for nursing facility care and assuring that facilities are in compliance with Medicaid regulations. In addition, the field review nurse is responsible for performing onsite reviews and monitoring compliance and reimbursement for Home Health Agencies for various programs provided through the Department for Medicaid Services.
-Perform RUG reviews in accordance with established guidelines.
-Review for PASRR compliance on initial review and then bi-annually during level of care
-Perform ancillary reviews for long-term care residents in accordance with established timeframes.
-Perform home health, home and community based waiver, early periodic screening, diagnosis, and treatment (EPSDT), Michelle P Waiver, Adult Day Health Care, and Model II Waiver reviews.
-Other duties as assigned.
Unrestricted active Kentucky Registered Nursing License.
-Associate degree or higher education in Nursing required.
-Three to five years' experience direct patient care/clinical required.
-Two to Five years' direct experience with long-term care and/or home health preferred.
-Knowledge of principles and procedures of Utilization Review as well as URAC standards preferred.
-Excellent interpersonal skills; oral and written communication, listening, problem solving, decision making, stress management, diplomacy, etc.
-Proficient in the use of Microsoft Word, Excel and Outlook.
-Must have a significant degree of comfort with the use of a lap-top.
-Must be proficient in typing. -Demonstrated leadership skills.
Job Location Louisville, Kentucky, United States Position Type Full-Time/Regular