Medical Review / MDS Registered Nurse

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POST DATE 8/14/2016
END DATE 11/15/2016

ALL's WELL Jacksonville, FL

Company
ALL's WELL
Job Classification
Full Time
Company Ref #
23016485.21602206
AJE Ref #
575879531
Location
Jacksonville, FL
Job Type
Regular
Required Licenses/Certifications
df-aj

JOB DESCRIPTION

APPLY
Hiring a Medical Review RN / MDS RN - Must be a Registered Nurse with an active Florida RN License

Job duties include but not limited to the following:

- Apply medical knowledge and expertise in reviewing claims and subscriber/ provider inquiries

- Practices, existence of medical necessity, level of reimbursement and extent of benefit coverage

- Document findings and render medical decision in systems

- Manage medical review inventory, to include resolving workflow problems and identifying medical cost savings

-Identify formal education opportunities and needs for providers and their staff and communicate these needs to appropriate departments

-Consult with Medical Director and other resources on issues related to claims, member and provider inquiries

-Follow regulatory requirements

-Project work as needed

-Moderate to heavy keying required

Requirements:

- Current, active Florida RN license

-2+ years of clinical nursing experience as an RN

- Excellent written and verbal communication skills

Job Requirements:

- Business Specific Criteria (preferred skills):

- Bachelors degree in Nursing

- Experience working with ICD-9, CPT-4 and HCPC coding

- Experience completing utilization review

- Experience with utilization management systems [Quest, Diamond, Convergence X, JIVA, CMCA, EIP) or clinical decision making tools such as Medical Coverage Guidelines (MCG), or InterQual

- Experience working with multiple research/processing systems

- Experience working with MS Word, Excel and PowerPoint

Must reside in the state of FL, open to FL residents only

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.