Precertification Nurse (Remote - East coast)
About Medlogix Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve. Overview: The role of Precertification Nurse is to perform Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries. Knowledge:
- New Jersey Auto PIP / No-Fault - Preferred
- InterQual/Review Manager/CERME
- CPT and ICD-9/ICD-10 diagnosis coding
- Medical management related to auto claims – Preferred
- Microsoft Office Suite programs
- Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
Skills:
- Strong interpersonal skills, communication and presentation
- Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes
- Ability to work independently
- Ability to provide instruction and direction to support staff
- Will be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing laws
- Must be detail oriented and able to multi-task
- Must be able to type 45-50 words per minute
Experience:
- 3 Years Med-Surg – Required
- Utilization Review – Preferred
- Ortho/Rehab – Preferred
Job Type:
- Full Time; home based
Required Education:
- Graduate of an accredited school of nursing
Required License or certification:
- Active Nursing License in good standing – LPN/RN