REGISTERED NURSE APPEALS WRITER CHECKLIST

		REGISTERED NURSE APPEALS WRITER CHECKLIST
NAME

LAST 4 OF SSN

DATE

	I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:	1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently

Rating Stars (Click)	KNOWLEDGE, SKILLS, ABILITIES		1	2	3	4
	Review, analysis and extraction of clinical information from patient records
	Drafting of effective narratives for Medicare and Medicaid appeals documentation
	Drafted briefs in support of denied cases under appeal at all levels of the government appeals process
	Maintained current knowledge base of medical coding
	Knowledge of federal and state hopsital Utilization Review ("UR") regulations
	Knowledge of of Medicare guidelines regarding medical necessity
	Knowledge of of Medicare guidelines regarding inpatient and outpatient observation
	Research and preparation for beneficiary hearings
	Experience testifying as expert witness in hearings
	Collaborated with internal and external legal sources
	Chart review skills
	Ability to quickly research and extract relevant data from a medical record
	Develop and Draft clear narratives for a solid case in support of medical claims for appeals
	Experience with electronic medical record
	Knowledge and experience with acute hospital utilization review using InterQual and/or Milliman
	Working knowledge of medical coding
	Knowledge and experience with case management
	Knowledge and experience with government and contacted payers
	Attention to details, timeliness and accuracy
	Ability to work independently while working efficiently
	Ability to work comfortably within a high production team
Rating Stars (Click)	SETTING		1	2	3	4
	Acute Care
	Skilled/LTAC
	MDS Coordinator
	Home Health
	Telephonic
	Workers Compensation
	Insurance
	Managed Care
	Acute Rehab
Rating Stars (Click)	CM/UR SOFTWARE		1	2	3	4
	Interqual
	Milliman
	MIDAS
	Allscripts UR
	Word Processing Software
	Other: Specify
	Other: Specify
Rating Stars (Click)	REGULATORY		1	2	3	4
	CMS/Medicare
	HEDIS Measures
	Core Measures
	Medicaid/Medical
	DRG
	ICD 9 Coding
	ICD 10 Coding
	CPT
Rating Stars (Click)	PROCESSES		1	2	3	4
	Benefits Eligibility
	Pre-Certification Review
	Review for Admission Criteria
	Identify Appropriate Level of Care
	Review Status During Stay
	Discharge Planning
	Physician Advisor
	Clinical Documentation Improvement
	Needs Assessment/Order DME
	Needs Assessment/Home Health
	Needs Assessment/Hospice
	Needs Assessment/Skilled
	Third Party Authorization Process
	Concurrent Review
	Retrospective Review
Rating Stars (Click)	PROFESSIONAL KNOWLEDGE AND SKILLS		1	2	3	4
	National Patient Safety Goals
	Age Specific/Population Based Care
Rating Stars (Click)	EMR		1	2	3	4
	Epic
	Cerner
	Eclipsys
	McKesson
	Meditech
	Other Computerized System
	Computerized Physician Order Entry
	Bar Coding for Medication Administration
MY EXPERIENCE IS PRIMARILY IN:
Unit	No. of Years	Unit	No. of Years
BURN		POST PARTUM
CRITICAL UNIT		LABOR & DELIVERY
PACU		NEWBORN NURSERY
NEUROLOGY		LEVEL II NICU
TELEMETRY		LEVEL III NICU
MEDICAL		PICU
SURGICAL		PEDIATRICS
ONCOLOGY		OB/GYN
ORTHOPEDICS		PSYCHIATRY
OPERATING ROOM		RRT
EMERGENCY ROOM		CRT
TRAUMA CENTER LEVEL 1
COMMUNITY ER
RURAL ER
Rating Stars (Click)	Age Specific Competencies		1	2	3	4
	Newborn/Neonatal (birth – 30 days)
	Infant (30 days-1 year)
	Toddler (1-3 years)
	Preschool (3-5 years)
	School Age Children (5-12 years)
	Adolescent (12-17 years)
	Young Adults (18-44 years)
	Middle Adults (45-64 years)
	Older Adults (>65 years)