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Medical Review Nurse - LPN

In Florida / United States

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Medical Review Nurse - LPN   

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JOB TITLE:

Medical Review Nurse - LPN

JOB TYPE:

JOB SKILLS:

JOB LOCATION:

Largo Florida / United States

JOB DESCRIPTION:

BTG, in partnership with a top ranked Health Insurance company in Florida, has an immediate need for a Medical Review Nurse to work in Largo, Florida. Requirements of the Position: Knowledge of medical terminology Experience with prior authorization Experience applying nationally recognized criteria, including InterQual Knowledge of Medicare regulations and guidelines Computer skills, including ability to use Microsoft Office suite Previous experience within a call-center environment Ability to navigate through multiple systems and screens to resolve authorization or medical review requests Talking and typing simultaneously Effective time management skills Effective interpersonal and communication skills Ability to use electronic medical record and claims systems Problem solving abilities Work cooperatively, positively, and collaboratively in an interdisciplinary team Work respectfully and positively with others Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames Ability to think analytically and make decisions Ability to manage large workload Essential Functions Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team. Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed. Maintain organized, updated reporting of activities with clear documentation. Required to track, monitor and report on the status of records and volume of work. Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports. Must have previous medical record / quality review experience; HEDIS/STARS preferred Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills Ability to communicate clearly verbally and in writing Organizational skills are very important; must be able to work independently to complete tasks with minimal direction. Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and time frames Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity Review cases and potential denials with the Medical Directors Research requests not clearly meeting established criteria Assist the Prior Authorization non-clinical reps with the Prior Authorization process Coordinate and maintain complete written documentation on all prior authorization's requests. Collaborate with other departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors. Log into phone queue to service providers Answer inbound calls regarding authorizations within established time frame Document contact information in electronic medical record system Maintain productivity Handle calls professionally Provide accurate prior authorization information to provider offices Benefits of the Position: Full time hours Medical / Dental / Vision 401k Preferred Qualifications: Disease management experience is helpful Recent experience in medical record reviews, data collection for HEDIS / Stars Required Experience: 2+ years related work experience Required Education: High School Diploma or GED Required Licenses and Certifications LPN - Licensed Practical Nurse - State Licensure If you believe that your skills and experience are a match for this position, please submit your most current resume and a recruiter will be in contact. Resumes can also be submitted via email to ************* or by applying online at https://jobs.btginc.com. You may also give us a call at 904-998-9414 to speak to a recruiter.

Position Details

POSTED:

Aug 13, 2022

EMPLOYMENT:

INDUSTRY:

SNAPRECRUIT ID:

S16204864802533279

LOCATION:

Florida / United States

CITY:

Largo

Job Origin:

CEIPAL_ORGANIC_FEED

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In Dallas Fort Worth
Aug 19, 2017 9am-6pm
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Medical Review Nurse - LPN    Apply

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BTG, in partnership with a top ranked Health Insurance company in Florida, has an immediate need for a Medical Review Nurse to work in Largo, Florida. Requirements of the Position: Knowledge of medical terminology Experience with prior authorization Experience applying nationally recognized criteria, including InterQual Knowledge of Medicare regulations and guidelines Computer skills, including ability to use Microsoft Office suite Previous experience within a call-center environment Ability to navigate through multiple systems and screens to resolve authorization or medical review requests Talking and typing simultaneously Effective time management skills Effective interpersonal and communication skills Ability to use electronic medical record and claims systems Problem solving abilities Work cooperatively, positively, and collaboratively in an interdisciplinary team Work respectfully and positively with others Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames Ability to think analytically and make decisions Ability to manage large workload Essential Functions Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team. Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed. Maintain organized, updated reporting of activities with clear documentation. Required to track, monitor and report on the status of records and volume of work. Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports. Must have previous medical record / quality review experience; HEDIS/STARS preferred Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills Ability to communicate clearly verbally and in writing Organizational skills are very important; must be able to work independently to complete tasks with minimal direction. Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and time frames Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity Review cases and potential denials with the Medical Directors Research requests not clearly meeting established criteria Assist the Prior Authorization non-clinical reps with the Prior Authorization process Coordinate and maintain complete written documentation on all prior authorization's requests. Collaborate with other departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors. Log into phone queue to service providers Answer inbound calls regarding authorizations within established time frame Document contact information in electronic medical record system Maintain productivity Handle calls professionally Provide accurate prior authorization information to provider offices Benefits of the Position: Full time hours Medical / Dental / Vision 401k Preferred Qualifications: Disease management experience is helpful Recent experience in medical record reviews, data collection for HEDIS / Stars Required Experience: 2+ years related work experience Required Education: High School Diploma or GED Required Licenses and Certifications LPN - Licensed Practical Nurse - State Licensure If you believe that your skills and experience are a match for this position, please submit your most current resume and a recruiter will be in contact. Resumes can also be submitted via email to ************* or by applying online at https://jobs.btginc.com. You may also give us a call at 904-998-9414 to speak to a recruiter.


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