Reviewing medical records and charts for all HEDIS measures. Performing data collection, data collection, and data review from electronic medical record and chart review. Reviewing data to ensure compliance to performance measures. Must meet the following requirements for consideration:
Coordinating services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff. Providing patient and provider education. Must meet the following requirements for consideration: Graduate from an Accredited School of Nursing. Current state’s RN license.
Facilitating many kinds of conversations – emergencies, medical procedures, legal situations. Position Requirements Include: Interpretation experience. Professional certification and training. A two to four year degree in interpretation.
Determine appropriate level of service. Perform clinical coding review to ensure accuracy of medical coding. Qualifications for this position include: High School Diploma or GED. 2+ years of current CPT and HCPCS coding experience. Licensed and unrestricted nurse (RN, LVN, or LPN)
Qualifications Include: High School Diploma / GED or higher. Certified Pharmacy Technician (CPhT), licensed practical nurse (LPN) or medical assistant (MA) 2 years of practice experience in health plan or PBM. Solid PC skills including MS Word, PowerPoint and Excel.
Expert knowledge of ICD and CPT coding systems, G-codes, HCPCS codes, CPT modifiers, MS-DRGs and APC. Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology. Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
A staffing agency is searching for a person to fill their position for a Remote Nurse Medical Reviewer. Individual must be able to fulfill the following responsibilities: Evaluating, identifying, and reporting on, quality of care issues. Receiving requests for pre-certification of procedures.
A healthcare company is in need of a Telecommute Medical Review Registered Nurse . Core Responsibilities Include: Conducting on-site reviews of subscriber medical information. Ensuring appropriate benefit administration. Compiling weekly, monthly and quarterly reports.
Core Responsibilities of this position include: Determining medical appropriateness of inpatient and outpatient services. Ensuring proper utilization of health services. Identifying solutions to problems and non-standard requests. Required Skills:
2+ years of acute hospital clinical experience. 4+ years of utilization management experience. In-depth knowledge of medical practices standards and benefit structures. Competency in all types of medical-necessity decisions. Familiarity with Milliman and InterQual guidelines.