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Professional Review Nurse

Employer
CorVel Corporation
Location
Charlotte, North Carolina
Salary
Not Specified
Closing date
Jun 15, 2019

View more

Category
Health and Medical
Job Type
Not Specified
Career Level
Not Specified

Job Details

JOB SUMMARY:
The Professional Review Nurse provides analysis of medical services to determine appropriateness of
charges on multiple types of medical bills to determine appropriateness of medical care.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Identify the necessity of the review process and communicate any specific issues of concern to
    the claims examiner/client and or direct reporting manager.
  • Collect supporting data and analyze information to make decisions regarding appropriateness of
    billing, delivery of care and treatment plans.
  • Appropriately document work and final conclusions in designated computer program.
  • Adhere to regular and consistent work attendance, complying with CorVel attendance policy as
    stated in the Employee Handbook.
  • Be responsive to additional Professional Review job duties as assigned by management or
    determined by legislative changes and/or market changes.
  • Be a team player working with other Professional Review Nurses and management/supervisors
    in a positive team environment
  • Comply with all safety rules and regulations during work hours in conjunction with the Injury
    and Illness Prevention Program (IIPP)
  • Additional duties as assigned

KNOWLEDGE & SKILLS:

  • Exceptional written and verbal communication skills in addition to excellent multi-tasking ability
    and exceptional active listening ability.
  • Ability to act as a mentor to Professional Review Specialists and assist with QA or owning office
    support as requested by management.
  • Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an
    understanding of medical terminology
  • Proficient in Microsoft applications and technical aptitude with ability to expand knowledge and
    proficiency in MedCheck's proprietary systems
  • Ability to work independently, follow process guidelines, meet productivity standards and
    timelines. (Must maintain a score of 98% or higher on performance audits).

EDUCATION/EXPERIENCE:

  • Associate's degree in Nursing
  • Must maintain current RN licensure in the state of employment.
  • Minimum of 4 years clinical experience
  • Must be computer literate
  • Previous experience in the following areas preferred:
  • Medical bill auditing
  • Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., and
    Orthopedics
  • Knowledge of worker's compensation claims process
  • Prospective, concurrent and retrospective utilization review
  • liability experience is a plus


#cb *mon*

Application Instructions:

In order to provide equal employment and advancement opportunities to all individuals, employment decisions at CorVel will be based on merit, qualifications and abilities. Except where required or permitted by law, employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex, national origin, ancestry, citizenship, age, handicap or disability, marital status, medical condition or any other characteristic protected by applicable law. Please be aware that CorVel generally does not review all applications submitted in response to job openings posted on the Internet because of the large volume of responses. Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.

Company

CorVel is looking for passionate, motivated individuals to join our team of associates and help us be successful by making a positive impact within our organization and for our clients. If you are interested in joining CorVel, review our available opportunities and submit your resume as indicated by the application instructions.

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