Job Description
NEED LOCAL ARIZONA RESIDENTS ONLY Candidate will go onsite for training 1-2 times for training once starting position
Compliance Items: - Active RN License in state of Arizona
- Fingerprint Clearance Card - Needed before start date.
- Candidate needs to obtain their own laptop
SOAZ - Posting ID # 5297 - Medical Review Nurse (Local Only/Mostly Remote/Onsite Trainings) Skills Required: •Medical nursing practice, medical case management protocols, quality management and utilization review protocols as related to all populations including Maternal and Child Health services, preventive health, family planning, sterilization, and pregnancy termination, EPSDT, acute, LTC, chronic long-term elderly and physical disabled, developmentally disabled, behavioral/mental health, and Tribal
•Healthcare delivery system nationally and locally
•Managed care processes
•Acute nursing processes including assessment, planning, intervention, and evaluation
•InterQual Criteria
•CCI
•Coding: CPT, HCPCS, ICD-9
•Medical Claims Review
•Statistical analysis
•Computer data retrieval and input
•Interpretation of governmental agencies
•AHCCCS Rules and Regulations
•Code of Federal Regulations
•Organizational skills that result in prioritization of multiple tasks
•Interpretation of rules, laws and agency policy pertaining to the AHCCCS program
•Good written and communication skills
•Computer skills
•Utilization Review skills
•Medical Claims Review skills
•Producing work products with limited supervision
•Effectively collaborating with people in positions of all levels
•Research and analysis
•Team player and can work independently
Abilities: •Interpret and apply medical and claims policies
•Read and interpret medical documentation
•Evaluate medical documentation for emergency criteria, medical necessity, correct CPT coding
•Determine appropriate hospital levels of care and lengths of stay
•Respond to inquiries for UR/CPT coding decisions
•Maintain data for monthly reports
•Work independently with minimal supervision
•Ability to work Virtual Office
Preferred Skills - Experience in concurrent and retrospective review; CCI, lnterQual, HCPCS and CPT Coding; managed care medical review experience. Certification in CPT Coding is a plus.
- Active Fingerprint Clearance Card
Compensation: $34.00 - $35.00 per hour
About SR International INC SR International has been a leading name among the IT consulting companies with offices in US and India. For past 16 years, our industry experience and domain knowledge have enabled us to provide innovative solutions to our customers.
Who We Are We Are Leading IT Based Solution Providers Today, the world of business information represents the realization of our collective efforts toward improving the future. Held only by the limits of our imagination, the business world is accelerating at an ever-increasing pace. Imagine a better way of doing business, of implementing the perfect software, of refining practice or business integration. All it takes are benchmark standards in service, support, and technical know-how, which have been our bread and butter.
Our Vision Established in 2002, SR International Inc is one of the fastest growing and reputed provider of Information Technology Services and Solutions in the USA. Since our inception, we have been a trusted IT partner for our clients. We take pride in our highly skilled IT Resources and unique engagement model. We have been consistently delivering on our promises as a high-performance team. Our expertise in Cloud Computing, Mobility, Web Technologies, ERP and CRM are second to none. Our industry-leading flagship product iMathSmart is re-defining math learning experience for school students.
Career At SR International At SR International, we treat our consultants like family. Our business and our reputation have been built and maintained by quality resources working onboard, so it's important for us to maintain the quality resource pool.
Job Tags
Hourly pay, Work at office, Local area, Remote work,