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LPN - Pre- and Post-Service Medical Review Nurse
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Information Technology company
ContractContract to Permanent
Information Technology company
Jacksonville, FL ( Map it )
No permanent US residency required
W-2 only
Jacksonville, FL
ContractContract to Permanent
This posting is no longer accepting new applicants
  • Apply medical knowledge and expertise in reviewing claims, authorization requests, and subscriber/ provider inquiries 
  • Render medical decisions on pre-service requests and post-service claims per established criteria, meeting compliance standards and timeframes 
  • Identifies questionable medical practices, existence of medical necessity, and extent of benefit coverage 
  • Document findings and render medical decision in various Florida Blue systems 
  • Manage medical review inventory, to include resolving workflow problems and identifying continuous improvement opportunities 
  • 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 /reviews 
  • Conducts telephonic reviews with ability to cover phones between 8am and 6pm daily.
  • Follow regulatory requirements 
  • Project work as needed 
  • Moderate to heavy keying required
Skills
Skill Proficiency Years Experience Percent Used
Medical Claims
1 - 3100%
Compliance
1 - 375%
Continuous Improvement
Any50%
Position Recruiter
Amber Hovey
amber@cloudteam.com
813-868-3833