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 Pre/Post Service Medical Review Nurse RN:
-
Employment Type:
Contractor
-
Location:
Jacksonville, FL (Onsite)
Do you meet the requirements for this job?
Pre/Post Service Medical Review Nurse RN
Careers Integrated Resources Inc
Jacksonville, FL (Onsite)
Contractor
Job Title: Pre/Post Service Medical Review Nurse RN
Job Location: Jacksonville, FL
Job Duration: 2-3 Months (Possibilities of Extension)
Shift: Monday - Friday, 8:00am - 5:00pm
Job Summary:
Job Location: Jacksonville, FL
Job Duration: 2-3 Months (Possibilities of Extension)
Shift: Monday - Friday, 8:00am - 5:00pm
Job Summary:
- This position serves as Client's clinical expert in working with providers, facilities and subscribers in overseeing the wellbeing of subscribers while ensuring the proper administration of benefits, cost effectiveness, and the coordination of the delivery of quality care.
- Conduct on-site review of subscriber's medical information in order to ensure appropriate benefit administration.
- Consult with providers, facilities' staff, subscribers and their families to ensure cost efficiencies in the delivery of care.
- Coordinate with internal and external sources in the on-going management of subscriber's care.
- Gather and review subscriber's medical information in order to schedule, based on criticality, on-site reviews.
- Apply clinical expertise in the completion of subscriber's medical documentation, which become legal documents and part of subscriber's file.
- Conduct weekly reviews with internal and external sources on the care and services provided by Client to subscribers.
- Compile weekly, monthly and quarterly reports used to determine cost savings, identify process improvement opportunities and document activities.
- Conduct training of new staff members and providers as needed.
- 1-year of utilization management experience.
- ICD-9 Coding
- Excellent planning, organizational skills.
- Excellent verbal and written communication skills.
- Self-starter
- Ability to work independently
- Conflict resolution
- Detail oriented
- Ability to handle multiple tasks
- Decision making skills
- Flexibility
- Basic PC knowledge
- Managed care experience
- Understanding of Regulatory Agencies
- Nursing - Related Bachelor's degree required.
- 3+ years related work experience or equivalent combination of transferable experience and education.
- Combined experience in utilization management, case management, home health and clinical.
- Florida license - Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure.
- Florida license - Non-Clinical\AZDL - Driver License - Valid And In State.
- Ability to work with multiple screens and systems
- Managed care experience, Including InterQual, NCD and LCD medical review criteria.
- Understanding of Regulatory Agencies
- Medicare Advantage Experience
- Prior FLBL experience
- Previous CMS experience and review of all organization determinations, including pharmacy reviews.
- Top candidates are those that have Jiva, Seibel, and Diamond experience.
- Remote - Florida.
- Must have a FL RN License - Unrestricted or Nursing Compact license.
Get job alerts by email.
Sign up now!
Join Our Talent Network!