medical records reviewer

Liberty Healthcare Corporation

<div>Registered Nurses are encouraged to consider a full-time Clinical Reviewer position with Liberty Healthcare.

As a Clinical Reviewer, you will be an active contributor with a large-scale program which endeavors to enrich the lives of older adults and people who are living with developmental disabilities.

Your role will focus on the review and analysis of health information of recipients of Medicaid HCBS waiver services, and your day-to-day responsibilities will include:
<ul>
<li>Reviewing medical records and personal health information</li>
</ul><ul><li>Conducting root cause analyses of critical incidents and deaths</li>
</ul><ul><li>Forming objective evidence-based opinions</li>
</ul><ul><li>Writing detailed reports</li>
</ul><ul><li>Leading and participating in committee and team meetings</li>
</ul><ul><li>Providing technical assistance and training</li>
</ul><ul><li>Collaborating with stakeholders</li>
</ul>
This is a remote-first position which will primarily allow you to work in your home office with an occasional need to attend in-person meetings in Nebraska. This is a non-direct care role which does not involve patient contact or nursing care.

As a valued full-time employee of Liberty Healthcare and Clinical Reviewer, you can expect:
<ul>
<li>$80,000 annual salary</li>
</ul><ul><li>Health insurance, dental insurance, vision insurance, life insurance, and disability insurance</li>
</ul><ul><li>30 days of paid time off each year for holidays, vacation, sick leave, and personal days</li>
</ul><ul><li>Health Savings Account, 401k plan, and other perks</li>
</ul>
Full details on Liberty's benefits plan are available at www.libertyhealthcare.com/upload/138.pdf
You are a good fit for this position if you possess the following:
<ul>
<li>Professionally licensed as a Registered Nurse in Nebraska</li>
</ul><ul><li>Experience providing nursing services to older adults and people who are living with developmental disabilities</li>
</ul><ul><li>Knowledge of quality assurance methodologies
</li></ul><ul><li>Outstanding analytical and report writing skills</li>
</ul><ul><li>Nebraska residency</li>
</ul>
Liberty Healthcare is an equal opportunity employer committed to diversity, equity, and inclusion. Our organization is composed of, and proudly serves, people of diverse backgrounds and abilities.

Click &ldquo;Apply&rdquo; and submit your resume for immediate consideration.</div>

Registered Nurse – Clinical Reviewer

Oregon Health & Science University

<div>Department Overview:
<div>
The Critical Care Services Clinical Reviewer is the primary clinical reviewer for the ELSO registry as well as the Get With the Guidelines Stroke Registry, with additional abstraction duties as required by manager (i.e. supporting additional stroke abstraction per DNV requirements). Primary site abstraction is for OHSU. Duties include collecting concurrent and retrospective data, assuring integrity of the data collection and data entry for</div><div>
data submittal and data repository, reporting clinical outcomes and descriptive data, and integrating findings into quality improvement activities. The incumbent is responsible for accurate and timely collection and transmission of data in accordance with the guidelines established and performing data queries of that database</div><div>
as requested. The clinical reviewer will stay pro-actively appraised of any definitional, specification, or reporting changes and will actively collaborate with the registry and associated vendors. This position collaborates with the ECMO coordinators, ECMO and neurology faculty and staff, Stroke Program Manager, quality management staff, and other clinical reviewers. They will also participate as a member in applicable best practice and quality committee meetings.</div>
Function/Duties of Position:
<div>
Data Collection and abstraction</div><ul><li>
identifies patients for inclusion in applicable registries</li><li>
navigates the electronic medical record system, Epic, to abstract concurrent and retrospective data on all patients meeting national registry guidelines</li><li>
finds, reads, and comprehends H&amp;Ps, discharge summaries, progress notes, procedure notes, labs, medications, and outside medical records within Epic</li><li>
orders records from outside facilities when necessary in order to complete all the data collection fields</li><li>
collaborates with physicians and patient care teams to determine data needs and evaluate clinical outcomes</li><li>
monitors accuracy of data via automated and auditing means</li><li>
updates data collection tool as appropriate and in accordance with registry definitions, specifications, and guidelines</li><li>
enters accurate and complete data in a timely manner, using the approved software</li><li>
updates database software and data fields as necessary</li><li>
ensures timely data entry and submittal, integrity of data, and implementation of quality control measure to assure accuracy and validity</li><li>
develops and updates standard work tools</li><li>
exports data to registries per guidelines and in accordance with data security and integrity standards</li><li>
develops efficiencies to improve data collection processes</li><li>
works collaboratively to develop processes and ensure timely and complete collection and entry of data</li><li>
identifies issues related to documentation and works with appropriate clinicians and informatics staff to make appropriate improvements</li><li>
identifies issues potentially related to clinical practice and guideline adherence and brings those to the attention of the quality director, service line director, and appropriate medical director</li></ul><div>
Data Reporting and Analysis</div><ul><li>
distributes national benchmarking reports to customers as appropriate and as requested by medical directors, service line directors, and clinical staff</li><li>
develops and provides descriptive, statistical, and comparative analysis and reports of data as requested (analysis and reporting would include narrative, tabular, and graphical documentation and presentation)</li><li>
works closely with physician champion, other clinical staff, supervisor, quality management staff, and hospital staff to identify opportunities for improvement</li><li>
develops and reports standardized queries, reports, and dashboards on a quarterly basis and additional queries as requested</li><li>
prepares and presents comprehensive reports to appropriate committees, management, and other audiences within defined timeframes</li><li>
establishes effective working relationships with medical and service line leadership for reliable and meaningful data interpretation and analysis</li><li>
coordinates data inquiries to promote research activities as requested</li><li>
actively participates in accreditation visits and preparation, and provides clinical outcome and performance improvement data as required</li><li>
prepares presentations / documentation and helps present during survey visits</li><li>
presents data to DNV during onsite and intracycle visits</li></ul><div>
Communication and software maintenance</div><ul><li>
collaborates with appropriate ITG staff to address software related issues and upgrades</li><li>
acts as primary liaison with ELSO and GWTG-Stroke, and any other registries as assigned by manager</li><li>
coordinates discussions with ITG on database-related interfaces
</li><li>communicates openly and effectively with certified software vendors
</li><li>works collaboratively with vendors to troubleshoot any database and software-related issues</li><li>
communicates with database registry staff</li><li>
keeps apprised of applicable changes
</li><li>briefs and updates cardiovascular service line and quality management staff as appropriate</li></ul><div>
Other Duties as Assigned</div>
Required Qualifications:
<ul><li><div>
A Bachelor&rsquo;s degree in finance, business management or related field; AND</div></li><li><div>
Two years of industry related experience that includes project management, financial accounting, management reporting and analysis of specialized work processes standards, regulations; statistics or quantitative analysis methods and procedures, OR</div></li><li><div>
An equivalent combination of education, training and/or experience.</div></li></ul><div>
Job Related Knowledge, Skills and Abilities (Competencies):</div><ul><li>
Experience in hospital department, clinic, patient care unit, clinical research, or medical record reviewer</li><li>
Clinical chart review and abstraction experience or experience in medical database entry
</li><li>Experience working with national registries or databases</li><li>
Proficient computer skills including the use of MS Office products, basic statistical skills, and the internet.
</li><li>Experience with relational databases and data quality methods
</li><li>Clinical knowledge and understanding of patient care.</li><li>
Experience in clinical chart review and abstraction.
</li><li>Excellent verbal and written communication skills.</li><li>
Must be able to perform the essential functions of the position with or without accommodation 
</li></ul>
Preferred Qualifications:
<ul><li>Degree in healthcare related field preferred</li><li>
clinical data collection experience
</li><li>experience with the heart failure patient population</li><li>
Access and Excel proficiency
</li><li>Quality improvement and patient safety knowledge and experience</li><li>
Advanced statistic knowledge and experience</li></ul>
Why apply to OHSU?: We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu</div>

Critical Care Services Clinical Reviewer (Business Data Analyst 3)

Pellettieri Rabstein & Altman

Job Overview:We are seeking a detail-oriented medical professional (such as a retired nurse, medical assistant, or healthcare worker) to support our Workers&rsquo; Compensation legal team.This role focuses heavily on reviewing and understanding medical records, treatment histories, and injuries. No prior legal experience is required &mdash; we will train the right candidate on the legal side.This is an ideal opportunity for someone with a clinical background who wants a flexible, part-time or full-time role in a professional office setting.Responsibilities<ul><li>Review, interpret, and summarize medical records, treatment plans, and physician notes</li><li>Identify key injuries, diagnoses, and treatment timelines in workers&rsquo; compensation cases</li><li>Communicate with medical providers to obtain records and clarifications</li><li>Assist attorneys in understanding medical aspects of cases</li><li>Organize and track medical documentation and case files</li><li>Support preparation for hearings by compiling medical summaries</li><li>(Secondary) Assist with basic legal documentation and case coordination (training provided)</li></ul>Qualifications<ul><li>Background in healthcare preferred (e.g., RN, LPN, medical assistant, physical therapy aide, etc.)</li><li>Strong understanding of medical terminology and treatment processes</li><li>Experience reviewing or working with medical records</li><li>Highly detail-oriented with strong organizational skills</li><li>Comfortable learning new systems and processes</li><li>No prior legal experience required (training will be provided)</li></ul>Bonus (not required):<ul><li>Prior exposure to workers&rsquo; compensation or personal injury cases</li><li>Experience in administrative or office settings</li></ul>Job Types: Full-time, Part-timePay: $35.00 - $45.00 per hourBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Medical Case Analyst (Workers’ Compensation)

Performant Financial Corporation

<div>ABOUT MACHINIFY:
In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify&rsquo;s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We&rsquo;re reshaping healthcare payment through seamless intelligence.
ABOUT THE OPPORTUNITY:
Expected Hiring Range: $84,000 - $100,000 (based on experience)
The Medical Review Nurse II - SNF/MDS primarily performs medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.
Key Responsibilities:<ul><li>
Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.</li><li>
Document all findings referencing the appropriate policies and rules.</li><li>
Generate letters articulating audit findings.</li><li>
Supporting your findings during the appeals process if requested.</li><li>
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.</li><li>
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.</li><li>
Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.</li><li>
Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members.</li><li>
Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.</li><li>
Interface with and support the Medical Director and cross train in all clinical departments/areas.</li><li>
Other duties as required to meet business needs.</li></ul>
Knowledge, Skills and Abilities Needed:<ul><li>
Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.</li><li>
Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding.</li><li>
Knowledge of insurance programs program, particularly the coverage and payment rules.</li><li>
Ability to maintain high quality work while meeting strict deadlines.</li><li>
Excellent written and verbal communication skills.</li><li>
Ability to manage multiple tasks including desk audits and claims review.</li><li>
Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.</li><li>
Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload</li><li>
Effectively work independently and as a team, in a remote setting.</li></ul>
Required and Preferred Qualifications:<ul><li>
Active unrestricted RN license in good standing, is required.</li><li>
Must not be currently sanctioned or excluded from the Medicare program by the OIG.</li><li>
Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.</li><li>
One (1) or more years' experience performing medical records review.</li><li>
One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required.</li><li>
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.</li></ul>
WHAT WE OFFER:
Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.
Physical Requirements &amp; Additional Notices:
If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee&rsquo;s responsibility to maintain this Internet access at their home office location.
The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.<ul><li>
Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.</li><li>
Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).</li><li>
Regularly sit/stand 8 or more hours per day.</li><li>
Occasionally lift/carry/push/pull up to 10lbs.</li></ul>
Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:<ul><li>
Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.</li><li>
Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.</li><li>
Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.</li><li>
Other requirements may apply.</li></ul>
All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify&rsquo;s Human Resources team to discuss further.
Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.
THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING</div>

Medical Review Nurse - SNF/MDS Auditor (Government-CMS RAC))

Windward Wellness

Job Summary We are seeking a dedicated detailed oriented and clinically minded team member to review chiropractic documenation and manage Requests for Services (RFS) for our veteran patients. This role is critical to ensure accurate medical documentation and timely authorization for continued care.Responsibilities<ul><li>Review chiropractic notes for accuracy, diagnoses, CPT coding, and medical necessity.</li><li>Ensure documentation supports continued care approvals.</li><li>Prepare and submit RFS for VA/TriWest patients.</li><li>Track authorizations and follow up on pending or denied requests.</li><li>Communicate with providers to correct or improve documentation.</li></ul>Requirements<ul><li>Strong attention to detail (this is essential)</li><li>Experience reviewing medical documentation</li><li>Familiarity with CPT and ICD 10 coding</li><li>Comfortable working with clinical notes, treatment plans and functional goals.</li><li>Ability to work independently and maintain accountability.</li></ul>Preferred<ul><li>Experience with VA/TriWest or insurance authorizations</li><li>Chiropractic, PT, acupuncture or medical office experience</li></ul>Pay: $21.00 - $24.00 per hourBenefits:<ul><li>Health insurance</li><li>Paid time off</li></ul>Work Location: In person

VA Care Coordinator

Staffing Solutions Organization LLC

<div>
 
 
 Ensure Quality Care Across Illinois&mdash;One Review at a Time.
 
 
 
 
 
 
 
 Nurse Reviewer &ndash; Illinois
 
 
 
 
 Location:
 
 Remote with on‑site visits across Illinois
 
 
 
 
 
 
 Position Overview
 
 
 
 The Nurse Reviewer conducts provider compliance reviews to ensure adherence to state regulations, quality standards, and program requirements. This role includes conducting onsite visits, evaluating documentation, and determining provider compliance. The Nurse Reviewer works independently, exercises sound judgment, and provides recommendations that guide provider improvement and support statewide oversight efforts.
 
 
 
 
 
 
 Duties &amp; Responsibilities
 
 
 <ul>
 <li>
 Build and maintain effective relationships with providers and users to support high‑quality customer service.
 </li>
 <li>
 Evaluate providers for compliance with applicable state and program regulations.
 </li>
 <li>
 Coordinate and schedule on‑site provider visits; clearly communicate visit requirements.
 </li>
 <li>
 Conduct compliance interviews with providers and gather all necessary information.
 </li>
 <li>
 Review provider documentation, policies, and business practices for regulatory alignment.
 </li>
 <li>
 Collect, organize, and submit documentation supporting compliance findings.
 </li>
 <li>
 Utilize technology and web‑based systems to convert paper documentation to electronic format.
 </li>
 <li>
 Conduct in‑person assessments of provider sites to evaluate compliance with oversight requirements.
 </li>
 <li>
 Summarize on‑site visit findings accurately and professionally.
 </li>
 <li>
 Exercise independent judgment to evaluate compliance and make final determinations based on documented evidence.
 </li>
 <li>
 Identify deficiencies and recommend appropriate next steps to support provider improvement.
 </li>
 <li>
 Analyze trends in non‑compliance and identify gaps in provider business processes.
 </li>
 <li>
 Provide timely recommendations and updates to the Supervisor.
 </li>
 <li>
 Maintain HIPAA standards and confidentiality at all times.
 </li>
 <li>
 Perform other duties as assigned.
 </li>
 </ul>
 
 
 
 
 
 Required Skills
 
 
 <ul>
 <li>
 Strong interpersonal skills with the ability to relate well to staff and providers.
 </li>
 <li>
 Active listening and effective communication skills.
 </li>
 <li>
 Proficiency in MS Word, Excel, Outlook, and web‑based applications.
 </li>
 <li>
 Process‑oriented and results‑driven work approach.
 </li>
 <li>
 Ability to foster teamwork and collaborate across levels of management and staff.
 </li>
 <li>
 Ability to work independently and within a team environment.
 </li>
 <li>
 Excellent written and verbal communication skills and customer‑service techniques.
 </li>
 <li>
 High accuracy, strong attention to detail, and commitment to quality.
 </li>
 <li>
 Proven ability to meet deadlines and follow strict standards.
 </li>
 <li>
 Ability to travel regularly to provider sites across Illinois.
 </li>
 </ul>
 
 
 
 
 
 Qualifications
 
 
 
 
 Education
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in any field (Nursing preferred)
 </li>
 </ul>
 
 
 Experience
 
 
 <ul>
 <li>
 Minimum
 
 2 years of clinical experience
 
 working with critical care providers, public health providers, or providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities.
 </li>
 <li>
 Minimum
 
 1 year of experience
 
 conducting quality assurance reviews.
 </li>
 </ul>
 
 
 Certification
 
 
 <ul>
 <li>
 Active Illinois Registered Professional Nurse (RN) license required.
 </li>
 </ul>
 
 
 
 
 
 Working Conditions
 
 
 <ul>
 <li>
 Remote work with
 
 2&ndash;3 on‑site provider visits per week
 
 throughout the state of Illinois.
 </li>
 </ul>
 
 
 
 
 
 Benefits (Through SSO)
 
 
 
 SSO offers a competitive benefits package that supports your health, financial well‑being, and long‑term growth, including:
 
 <ul>
 <li>
 Medical, dental, and vision insurance
 </li>
 <li>
 401(k) with discretionary employer match
 </li>
 <li>
 Paid time off and holidays
 </li>
 <li>
 Flexible spending accounts
 </li>
 <li>
 Additional employee perks
 </li>
 </ul>
 
 
 
 
 
 Keyword Search Terms
 
 
 
 Nurse Reviewer, RN Reviewer, Provider Management Specialist, Compliance Nurse, Healthcare Quality Review, Provider Compliance, Medicaid Compliance, Clinical Reviewer, Illinois RN, Site Visit Nurse, Healthcare Auditor, Public Health Nursing, QA Nurse, Provider Monitoring.
 
</div>

Nurse Reviewer

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10000 medical records reviewer jobs Near Me

Registered Nurse – Clinical Reviewer

Registered Nurse – Clinical Reviewer

Critical Care Services Clinical Reviewer (Business Data Analyst 3)

Medical Case Analyst (Workers’ Compensation)

Medical Review Nurse - SNF/MDS Auditor (Government-CMS RAC))

VA Care Coordinator

Nurse Reviewer