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Medical Review Nurse - REMOTE
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Information Technology company
Contract
Information Technology company
Jacksonville, FL ( Map it )
No permanent US residency required
W-2 only
Jacksonville, FL
Contract
This posting has been closed

Job Duties include but are not limited to the following:

  • Evaluate members in the Acute Hospital, LTAC, Acute Inpatient Rehab and/or Skilled Nursing Facility for benefit determination, medical necessity and appropriate level of care
  • Participate in weekly case review
  • Plan, implement, coordinate and monitor care coordination activities that focus on acute and non-acute services, outpatient services and or community resources for Medicare Advantage lines of business
  • Monitor member’s discharge status, identify and coordinate any additional needs or services for successful discharge/transition in care
  • Collaborate with Medical Directors, Managers, Peers and other departments (e.g. Case Management)
  • Responsibilities are not all inclusive (e.g., project work may be requested in addition to other responsibilities)
  • Moderate to heavy keying required.


Requirements:

  • Current Florida RN license
  • 2+ years of recent (within the past 3-5 years) clinical experience in a Hospital, LTAC, Rehab, SNF setting evaluating hospital benefit determination, medical necessity and appropriate level of care, esp. Utilization Management
  • Experience in one or more of the following: Utilization Review, Discharge Planning or Case Management
  • Experience with the Healthcare industry and Managed Care
  • Proficient in MS Word, Excel and multiple computer applications
  • Knowledge of NCQA/CMS Standards
  • InterQual/MCG (Milliman) Care Guidelines
  • Occasional travel within the State of Florida


Preferred skills:

  • Bachelor’s degree in related field (i.e. Nursing, Healthcare, Business)
  • Case Management Certification (CCM)
  • Bilingual


Can be remote anywhere in Florida.

Skills
Skill Proficiency Years Experience Percent Used
Nursing
Any100%
Business Analysis
Any75%
EMR
Any75%
Medical Claims
Any75%
Medical Records
Any75%
Microsoft Excel
Any75%
HEDIS
Any50%
Medicare
Any50%