Senior Medical Review Nurse (CCM) - REMOTE
Information Technology company
Information Technology company
W-2 and C2C availableContract253 views
Jacksonville, FL 32256
Contract
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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)