New Jersey Licensed Precertification Nurse
Job Summary
To determine the medical necessity of requested services for New Jersey Auto No-Fault injuries, the full-time New Jersey Licensed Precertification Nurse will perform precertification duties remotely while collaborating with healthcare providers and educating patients on the precertification process.
Key responsibilities
- Conduct precertification reviews to assess the medical necessity of services requested for auto-related injuries
- Educate patients and healthcare providers about the precertification process and relevant regulations
- Utilize medical coding knowledge and software tools to support decision-making in the precertification process
Required qualifications
- Active New Jersey State Nursing License in good standing (LPN/RN)
- Graduate of an accredited school of nursing
- Minimum of 3 years of Med-Surg experience
- Familiarity with New Jersey Auto PIP/No-Fault and medical management related to auto claims is preferred
- Experience with InterQual/Review Manager/CERME and CPT/ICD-9/ICD-10 coding is preferred
Complete Job Description
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