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RN - Medical Reviewer (5678)

Claims Review Mgmt | Nashville, TN | Contract

Job Description
RN - Medical Reviewer
Work Location: Nashville, TN

InGenesis is currently seeking a Registered Nurse – Medical Reviewer to perform medical reviews using clinical/medical information and established criteria or clinical guidelines. In this role, you will provide support and review of medical claims and utilization practices.

If you meet the qualifications outlined below, apply today and we’ll reach out to answer any questions you may have!

Job Duties/Responsibilities/Functions (including but not limited to)
• Perform reviews for medically complex service claims, services that require preauthorization, requests for reconsideration, referrals for potential fraud, etc.
• Make reasonable charge payment determinations.
• Determine medical necessity and appropriateness of services.
• Document medical rationale to justify payment or denial of services/supplies.
• Provide guidance, direction, and input as needed to LPN team members.
• Provide education to non-medical staff.
• Perform other duties as assigned.

Minimum Qualifications
• Active, unrestricted Registered Nurse (RN) license in the state of TN.
• Associate degree in Nursing or graduate of accredited nursing school.
• 2+ years of clinical experience.
• Experience in utilization or medical review, preferred.

Soft Skills
• Working knowledge of managed care and various forms of health care delivery systems.
• Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.
• Knowledge of specific criteria/protocol sets and the use of the same.
• Working knowledge of word processing software.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Demonstrated customer service and organizational skills.

About InGenesis
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.

EEOC Statement
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.