Nurse Remote Medical Review Specialist at Le CYR Consulting

Medical review responsibilitiesComplex Medicare claims/prior authorization requests require the review of medical record documentation to determine the reasonableness and necessity of the billed service in accordance with Medicare rules and regulations. Reviews are performed by specially trained clinical staff using various methods to track the assignment, progress, and resolution of claims/cases. For complex claim reviews, the Companies are required to use Registered Nurses ("RNs"). Clinical decisions will be based on CMS policies/procedures defined in the CMS Internet-Only Manual (IOM), Company policies/procedures, Title XVIII of the Social Security Act (Section 1862), generally accepted standards of medical practice, clinical knowledge, contract guidelines, applicable Code of Federal Regulation guidelines, or other relevant statutory authority as applicable. Staff will perform this work for Medical Reviews, Appeals, and/or Prior Authorization requests.Qualified Staff and Work Location RequirementsA valid RN license in any state and two years of clinical experienceBi-lingual preferred (not required)Associates DegreePreferred background in Home Health or Skilled nursingMust have access to high-speed internet and be provided hardware for processing reviewsMust be available to perform work within the Company-specified core hours of 9:00 AM – 3:00 PM EST based on system availabilityPay rate between $30-$34 per hour plus benefits

Nurse Remote Medical Review Specialist

Emma

Responsibilities

Skills wanted:

Language(s) required:

About Le CYR Consulting:

lecyrconsulting.com/

Admin access needed