Medical Review Nurse RN -Remote

Full time @Nursetohire in Acute Care Practitioners Nurse , in Nurse
  • Post Date : November 4, 2022
  • Apply Before : November 4, 2028
  • Salary: $13.00 - $15.00 / Hourly
  • 0 Application(s)
  • View(s) 123
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Job Detail

  • Job ID 7070
  • Offered Salary 1000
  • Experience 2 Years
  • Industry Management
  • Qualifications Medical

Job Description

Full Job Description

Are YOU ready to expand your nursing career where you can achieve work life balance? If so, read on and get ready to Apply!

We offer benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise. Just think no nights, weekend or shift work!

What will you be doing:

The incumbent will serves as BCBSF’s clinical expert in working with providers, facilities and subscribers in overseeing the wellbeing of subscribers while ensuring the proper administration of benefits, cost effectiveness, and the coordination of the delivery of quality care.

Important Information: Hours that will be required to work is from 10:00am – 6:30 pm Monday thru Friday.

What will be your purpose:

  • Conduct on-site review of subscriber’s medical information in order to ensure appropriate benefit administration. Consult with providers, facilities’ staff, subscribers and their families to ensure cost efficiencies in the delivery of care. Coordinate with internal and external sources in the on-going management of subscriber’s care.
  • Gather and review subscriber’s medical information in order to schedule, based on criticality, on-site reviews. Apply clinical expertise in the completion of subscriber’s medical documentation, which become legal documents and part of subscriber’s file.

Required Work Experience:

  • 3+ years related work experience or equivalent combination of transferable experience and education. Experience Details: Combined experience in utilization management, case management, home health and clinical
  • Must be a Registered Nurse – State Licensure and/or Compact State Licensure Florida license
  • Valid Florida Driver’s license
  • Basic PC knowledge
  • Managed care experience
  • Understanding of Regulatory Agencies

What we prefer:

  • 1 year utilization management experience
  • ICD-10 CPT or HCPC Coding
  • Excellent planning, organizational skills
  • Excellent verbal and written communication skills
  • Self-starter
  • Ability to work independently
  • Conflict resolution
  • Detail oriented
  • Ability to handle multiple tasks
  • Decision making skills
  • Flexibility
  • Experience with MCG or InterQual

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