RN Clinical Reviewer

Job Title : RN Clinical Reviewer

Location : New York, NY 10004

Duration : 3+ Months / 13 Weeks

Education : Bachelor's in Nursing (BA / BSN) required

Shift Details : 9 : 00 AM – 5 : 00 PM / Hybrid — Onsite & Remote

Specific Skills :

• Review medical charts for accuracy, completeness, and proper diagnosis sequencing.
• Validate clinical and coding assessments in alignment with regulations.
• Conduct audits of high-risk claims and billing patterns to identify discrepancies and potential FWA.
• Prepare detailed clinical review reports, including rationale, research, and corrective action recommendations.
• Assist with documentation for audits, compliance reviews, recoupments, and regulatory inquiries.
• Active New York State RN License (Primary Source Verified)
• Minimum 2 years of clinical experience
• 5+ years of Healthcare Experience required

General Description :

We are seeking an experienced Registered Nurse (RN) to perform detailed medical chart reviews to ensure accuracy, correct sequencing of diagnoses, and compliance with regulatory guidelines. The RN will review documentation from Consultation Reports, H&P, Operative Reports, Progress Notes, and Discharge Summaries, including complex cases.