Senior Medical Review Nurse (CCM) - REMOTE
Information Technology company
Information Technology company
Jacksonville, FL 32256
W-2 and C2C availableContract249 views
Jacksonville, FL 32256
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.

Job 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
  • Case Management Certification (CCM)
Skills
Skill Proficiency Years Experience Percent Used
Medical Records
Any100%
Nursing
1 - 3100%
EMR
Any75%
HIPAA
Any75%
Medical Claims
Any75%
Microsoft Excel
Any75%
Microsoft Office
Any75%
CDISC
Any25%
FOCUS
Any25%
HP SHR
Any25%
Medicare
Any25%
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