Medical Review Nurse III
Medical Review Nurse III
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Salary Not Disclosed
1 Vacancy
Job Description
Medical Review Nurse III
Responsibilities:
- Perform medical chart reviews of automated and complex medical records and claims in accordance with Federal regulations and guidelines.
- Conduct accuracy reviews as part of special studies requested by CMS.
- Compile reports of analysis and recommendations to submit to CMS.
- Assess investigative and medical review findings and analyze claims data to detect patterns of potential fraud waste and abuse.
- Perform accuracy reviews of medical records and claims ensuring compliance with regulatory requirements.
- May handle more complex reviews and audits.
Qualifications & Requirements:
- Registered Nurse (RN) with a current unobstructed license to practice in the United States.
- Graduate of a Boardapproved Registered Nursing program.
- Bachelors Degree in Nursing (BSN) or a related field is preferred.
- Certification in medical coding is highly preferred.
- Minimum of three 3 years of clinical experience in an acute care hospital skilled nursing facility or office/clinicbased medical practice.
- Minimum of three 3 years of experience in medical/utilization review particularly with Medicare and/or Medicaid.
- Proficiency in research interpretation and application of Medicare Medicaid and local healthcare regulations and policies.
- Strong proficiency in Microsoft Office Suite including Outlook Excel and Word.
Employment Type
Full Time
