Registered Nurse Clinical Readmission Manager

To enhance healthcare outcomes, the full-time Remote Registered Nurse Clinical Readmission Manager will conduct prepayment and post-payment clinical reviews of inpatient admissions and related readmissions, ensuring compliance with organizational and regulatory guidelines. Key responsibilities Conduct clinical reviews of inpatient admissions and related readmissions within 30 days of prior discharge, assessing clinical relationships and potential consolidations Apply established guidelines and criteria consistently when evaluating cases and prepare clear, objective documentation of findings Collaborate with internal teams to address complex cases and support the dispute and appeal processes through thorough documentation Required qualifications Current, active, and unrestricted RN license in at least one U.S. state Five or more years of experience in clinical nursing, healthcare audit, or related environments with a focus on inpatient hospital readmissions Strong knowledge of inpatient clinical care, disease processes, and discharge planning Experience in reviewing medical records and synthesizing clinical information from multiple sources Ability to prepare clear and defensible clinical rationales and documentation for review findings