Sr. Nurse Clinician

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Summary:
This professional clinician will provide detailed and comprehensive written summaries to support the Corporate Medicare Appeals Process. Ability to render critical clinical assessment, analysis and case support in written form with a broad medical knowledge base is essential. The employee presents evidentiary testimony in formal hearings, and acts as a professional witness in various settings before Administrative Law Judges (ALJs). The employee must be astute and articulate in describing multiple clinical conditions, medications, and co-morbidities as they relate to medical necessity for power wheelchair and Power Operated Vehicles. The employee must be able to work in a multi task setting and be able to interact effectively with various health care professionals as well as attorneys, hearing officers, Judges, and Medicare physicians and nurses. The employee must be familiar and stay current with the DMERC/ Medicare reimbursement process.

Essential Duties and Responsibilities:
Ability to independently analyze and interpret clinical descriptions and documents that are in the appeals process and be able to draw relevant inferences and interpret evidence for successful Medicare reimbursement.
Ability to write complex clinical summaries and other documents in a prescribed format.
Supervise and train other clinical nurses and act as coordinator of workflow and processes.
Superior ability to interface in a positive verbal manner with a variety of interdisciplinary professionals.
Possess a clear and detailed understanding of Medicare Compliance as it relates to Power wheelchairs and POVs.
Provide educational opportunities for health care professionals, attorneys, judges, interdepartmental peers, and other principles within The SCOOTER Store.
Ability to communicate complex medical issues and concepts to management, attorneys and other Judicial personnel.
Ability to define problems, collect data, establish facts and draw valid conclusions.
Ability to interpret an extensive variety of technical information and deal with abstract and concrete variables.
Ability to work with specific computer software (Outlook, Word, Excel, PowerPoint, etc.).
Familiarity with special terminology such as medical or legal terms.
Ability to present a clinical argument accurately & convincingly for establishing medical necessity in front of an Administrative Law Judge.


Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
? Read, analyze, and interpret the most complex documents.
? Write complex documents in a prescribed format
? Effectively present information to management, attorneys, Judges physicians and other health care professionals.
? Ability to deal with a variety of abstract and concrete variables
Working knowledge of Product line.
Working knowledge of HCPC and ICD 9 codes

Education and/or Experience:
Current Texas Nursing License, LVN/RN with 1- 3 years of clinical nursing experience.

Certificates, Licenses, Registrations:
Current Texas Nursing License



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For quick consideration apply here