US
0 suggestions are available, use up and down arrow to navigate them
PROCESSING APPLICATION
Hold tight! We’re comparing your resume to the job requirements…
ARE YOU SURE YOU WANT TO APPLY TO THIS JOB?
Based on your Resume, it doesn't look like you meet the requirements from the employer. You can still apply if you think you’re a fit.
Job Requirements of Medical Review Nurse (RN):
-
Employment Type:
Contractor
-
Location:
Fort Lauderdale, FL (Onsite)
Do you meet the requirements for this job?
Medical Review Nurse (RN)
Careers Integrated Resources Inc
Fort Lauderdale, FL (Onsite)
Contractor
Job Title: Medical Review Nurse (RN)
Job Location: Fort Lauderdale, FL
Job Duration: 2-3 Months (Possibilities of Extension)
Job Summary:
Job Location: Fort Lauderdale, FL
Job Duration: 2-3 Months (Possibilities of Extension)
Job Summary:
- The Medical Review Nurse LPN reviews, authorizes, coordinates, and responds to requests for services for Client members.
- This position also communicates telephonically with providers and their offices, and occasionally with members.
- Makes decisions based on established policies and procedures, Client medical coverage guidelines, benefits, InterQual criteria, nursing knowledge.
- Refers cases to Client medical directors for potential denial.
- Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and timeframes.
- Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity.
- Review cases and potential denials with the Medical Directors.
- Research requests not clearly meeting established criteria.
- Assist the Prior Authorization non-clinical reps with the Prior Authorization process.
- Coordinate and maintain complete written documentation on all prior authorization’s requests.
- Collaborate with other Client departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors.
- Log into phone queue to service providers.
- Answer inbound calls regarding authorizations within established time frame.
- Document contact information in electronic medical record system.
- Maintain productivity.
- Handle calls professionally.
- Provide accurate prior authorization information to provider offices.
- 0-2 years related work experience.
- Previous experience within a call-center environment.
- Experience with prior authorization.
- Experience applying nationally recognized criteria, including InterQual.
- Highschool Diploma or GED.
- RN - Licensed Practical Nurse - State Licensure.
- Knowledge of medical terminology.
- Knowledge of Medicare regulations and guidelines.
- Computer skills, including ability to use Microsoft Office suite.
- Ability to navigate through multiple systems and screens to resolve authorization or medical review requests.
- Talking and typing simultaneously.
- Effective time management skills.
- Effective interpersonal and communication skills.
- Ability to use electronic medical record and claims systems.
- Problem solving abilities.
- Work cooperatively, positively, and collaboratively in an interdisciplinary team.
- Work respectfully and positively with others.
- Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames.
- Ability to think analytically and make decisions.
- Ability to manage large workload.
- Understanding of CMS rules and regulations.
- Ability to toggle between multiple systems.
- Ability to work weekend/holiday hours on rotation.
Get job alerts by email.
Sign up now!
Join Our Talent Network!