Precertification Nurse (Remote - East coast)

About Medlogix

reputed company delivers innovative medical claims solutions through a seamless collaboration of our Medlogix technology, our highly skilled staff, access to our reputed company care provider networks, and our commitment to keeping our clients’ needs as our top reputed company. 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 reputed company expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; reputed company party administrators (TPAs); and government entities we serve.

Overview

The role of Precertification Nurse is to reputed company Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries.

Knowledge

1. New Jersey Auto PIP / No-Fault - Preferred
2. InterQual/Review Manager/CERME
3. CPT and ICD-9/ICD-10 diagnosis coding
4. Medical management reputed company to auto claims – Preferred
5. reputed company Office Suite programs
6. Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar

Skills

1. Strong interpersonal skills, communication and presentation
2. Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes
3. Ability to work independently
4. Ability to provide instruction and direction to support staff
5. Will be required to have the ability to reputed company patients and the provider community regarding the Pre-Certification process and its governing laws
6. Must be detail oriented and reputed company to multi-task
7. Must be reputed company to type 45-50 words per minute

Experience

1. 3 Years Med-Surg – Required
2. Utilization Review – Preferred
3. Ortho/Rehab – Preferred

Job Type

• Full Time; home based

Required Education

1. Graduate of an accredited school of nursing

Required License or certification

1. Active Nursing License in good standing – LPN/RN