Clinical Documentation Reviewer, RN

📋 Description

• Conduct clinical review of Level of Care assessments, enrollment documentation, tracker
• Utilize approved Central ERD criteria, organizational guidelines, professional nursing judgment
• Identify medical, functional, psychosocial, behavioral health, cognitive, housing, home safety, and
• Identify cases requiring escalation or additional evaluation by Medical Directors, Executive
• Document review findings, classification considerations, follow-up needs, recommendations, and
• Participate in Central ERD meetings, case review discussions, and related process cadence to

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in good standing required
• Minimum of three (3) years of PACE experience
• PACE managed care, utilization review, care coordination, quality review, or regulatory healthcare
• Demonstrated experience reviewing clinical documentation, conducting clinical assessments
• Strong clinical judgment, critical thinking, and ability to identify potential participant safety
• Experience using Excel, Word, Teams, electronic health records, enrollment trackers, clinical

🎁 Benefits

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - 17 days of personal time off (PTO), 12 paid holidays, and 6 sick days
• 401(k) savings plan + employer match
• Comprehensive compensation package including base pay and bonus
• Additional benefits