Similar Jobs

View More

RN Utilization/Concurrent Review Opportunity

This job is no longer active. View similar jobs.

POST DATE 8/20/2016
END DATE 12/13/2016

ALL's WELL West Palm Beach, FL

West Palm Beach, FL
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Required Licenses/Certifications
Min Salary
Max Salary
Salary Unit
per hour


Remote/Work from Home
Work Schedule: M-F, 8:00 a.m. - 5:00 p.m.
6 Month then Temp to Permanent

?Experience completing utilization review
?Familiar with the use of decision making criteria tools (e.g., InterQual, Medical Coverage Guidelines, Medical Necessity, Medicare National Coverage Determination (NCD, Local Coverage Determination (LCD), and Internet only manual for Medicare (IOM)
?Working knowledge working with Current Physician Terminology (CPT) and International Classification of Disease (ICD 9 and ICD 10) coding
?Has a working knowledge of claims components (Post Service)
?Follows and maintains compliance with regulatory requirements (e.g., National Committeee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS)
?Medical Member and Provider Appeals knowledge and experience
?Ensure medical necessity and experimental/investigational claims were processed correctly according to multiple coverage guidelines
?Render medical decisions on claims, identifying questionable medical practices
? Authors within final document to provider appropriate statement supporting final determination
Conducts UM review and discharge planning at the facility level (e.g., Acute, Long Term Acute Care (LTAC), Skilled Nursing Facility (SNF), Acute Inpatient Rehabilitation

The job titles this role typically fill are: Concurrent Review Nurse RN, Pre/Post Service Medical Review RN, Healthcare Appeals Disputes RN, and Healthcare Appeals RN

Candidates may also be asked to train in other clinical roles to support the business.

?Strong computer skills
?2 plus years of utilization management/clinical nursing experience
?Current RN license (must be able to receive a FL RN license within a month of hire)
?Excellent verbal and written communication skills
?Proficient in Microsoft office
Preferred: Bachelors of Science Nursing ( BSN)

Job Expectations:

?Must work non-traditional hours to meet the member?s availability
?Must meet speed test requirements to participate in an interview.
?This is teleworker role which means the candidate will work remotely from home. Only candidates that pass the speed test requirements will receive an interview. Selected candidates, once hired, will be provided a soft key fob (accessible via mobile app that can be downloaded via a smartphone) to access (FB) Network. The candidate will use their personal desktop PC to participate in our training program and to perform assigned duties. (No other equipment is provided by FB for the On Demand Float Pool resources)
We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.