Home Health/Medicare RCD Clinical Reviewer - Now Hiring
•Today
| Estimated Pay info | Based on similar jobs in your market$30 per hour |
|---|---|
| Hours | Full-time, Part-time |
| Location | Vicksburg, MS, United States Vicksburg, Mississippi open_in_new |
About this job
Compensation rate: $65K annual
Start Date: December 2026
Key Responsibilities:
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Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria.
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Document review outcomes (affirmation/non-affirmation) with well-defined clinical rationale in the designated case management system, ensuring a turnaround time of within 7 business days.
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Engage with providers, as authorized, to request or clarify documentation, and escalate any provider concerns or suspected fraud in accordance with established program procedures.
- Maintain a standard of 98% accuracy and fulfill all required training, quality assurance reviews, and inter-rater reliability sessions.
- All RN Medical Reviewers must possess the following minimum qualifications: an active, unrestricted RN license in their state of residence.
- A minimum of 2 years of clinical experience, along with at least 2 years of experience in home health, quality assurance, or utilization review.
- Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity.
- Proficiency in ICD coding.
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Full-time Jobs Part-time Jobs Gig Jobs Posting ID: 1303877329 Posted: 2026-10-10 Job Title: Home Health
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