Medical Reviewer

At Elara Caring we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals providing the Right Care at the Right Time in the Right Place.

Job Description:

At Elara Caring we care where you are and believe the best place for your care is where you live. We know theres no place like home and thats why our teams continue to provide high-quality care to more than 60000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Medical Reviewer. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers.

To continue to be an industry pioneer in delivering unparalleled care we need a Medical Reviewer with commitment and compassion. Are you one of them If so apply today!

Why Join the Elara Caring mission

• Work in a collaborative environment.
• Be rewarded with a unique opportunity to make a difference
• Competitive compensation package
• Tuition reimbursement for full-time staffand continuing education opportunities for all employees at no cost
• Opportunities for advancement
• Comprehensive insurance plans for medical dental and vision benefits
• 401(K) with employer match
• Paid time off paid holidays family and pet bereavement
• Pet insurance

As a Medical Reviewer youll contribute to our success in the following ways:

• Maintains productivity quality and accuracy targets set by the Governmental Review Manager
• Promotes compliance with all regulatory standards through review of medical records.
• Collects appropriate medical records reviews the documentation for validity and submits the requested documents for pre-claim reviews ADR requests and/or appeals.
• Communicates with agencies related to documentation needs in a timely manner and follows up with agency leadership as needed.
• Conducts audits of medical record documentation for skilled home health hospice and PCS as needed to ensure documentation adequacy.
• Communicates significant findings problems and changes related to compliance with documentation standards to the Governmental Review Manager and other personnel involved with patient care.
• Identifies and communicates to the Governmental Review Manager and other supervisory personnel visit documentation that lacks adequate content to support billing guidelines.
• Participates in the development of strategies/education to prevent loss of revenue during recovery audits.
• Assists with development of staff education tools/guides to promote appropriate clinical documentation and utilization.
• Writes business letters and reports to explain determinations and decisions to a variety of audiences including but not limited to governmental payers private insurance providers and administrative law judges.
• Participates in all levels of appeal as needed using regulatory guidance and critical thinking to navigate appeals compliantly.
• Promotes coordinates and evaluates operational Systems to enhance operations and promote efficiencies.
• Provides leadership to team and support staff in identifying agency/client needs and opportunities for improvement.

What is Required

• Requires a high school diploma or GED.
• Graduated with a diploma from an accredited school as a Licensed Practical Nurse or Licensed Vocational Nurse.
• Minimum of three (3) years of experience as a licensed practical nurse or licensed vocational nurse in a home health and/or hospice clinical care setting is required.
• Prior functional working experience in medical records review arena (Utilization Review Case Management and knowledge of appropriate billing and coding guidelines) is preferred.

• Current License as a Licensed Practical Nurse or Licensed Vocational Nurse is required.

You will report to the Supervisor Pre Claim Review.

The base salary for this position is$60000-$65000 and is based on the companys good faith estimate at the time of posting. Actual pay will be determined based on factors such as education experience skills and internal equity.

Equal Employment Opportunity: We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited hired assigned and promoted without regard to race national origin religion age color sex sexual orientation gender identity disability protected veteran status or any other protected characteristic. If you require assistance due to a disability in the application or recruitment process please submit a request via email at

Pay & Benefit Information: Compensation for this role will be determined based on a variety of factors including qualifications skills competencies and relevant experience. Elara offers a broad range of benefits. Learn more at Elara Caring participates in E-Verify after a job offer is accepted and Form I-9 completed.