Precertification Nurse (Remote - East coast)

Job Description

Job Description

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 :

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 related to auto claims – Preferred
5. Microsoft 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 educate patients and the provider community regarding the Pre-Certification process and its governing laws
6. Must be detail oriented and able to multi-task
7. Must be able 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