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Medical Bill Review Nurse Case Manager Greensboro, NC

Location:Greensboro, NC
Employment Type:Full Time
Department:Other
Description:  Key Risk, a division of Berkley Insurance Company, a leading provider of workers compensation insurance products and services for employers throughout the Eastern United States, is accepting applications for a Medical Bill Review Nurse Case Manager to be located in the office in Greensboro, NC.  A successful candidate will be responsible for assessing, planning, coordinating, monitoring, and evaluating by telephone the medical care coordination and return to work coordination of assigned cases.  Priority is placed on early intervention to facilitate timely medical care and minimize injured worker's time out of work.

 

Duties:Review and analyze medical records and assess data to ensure appropriate billing.

Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care.

Conduct Utilization Review interventions according to Key Risk UR Practice Standards, Policies and Procedures.

Coordinate services to include home health services, durable medical equipment, IMEs, admissions, discharges, when appropriate and evaluate cost effectiveness and quality of services.

Document activities and negotiations using appropriate methods and tools following best practices for quality assurance.

Perform other duties and special projects as assigned by cost containment manager or assistant vice president of managed care.

 

Qualifications: 
  • Graduate of an accredited school of nursing and possess a current RN license.  BSN preferred. Must possess any necessary state required professional licensure.
  • Three to five (3-5) years' experience in insurance utilization review, telephonic case managements, and/or medical case management preferred.
  • Certification as a Certified Case Manager (CCM), a Certified Registered Rehabilitation Nurse (CRRN), and Certified Disability Management Specialist (CDMS), or a Certified Occupational Health Nurse (COHN) preferred. 
  • Possess knowledge of principles of insurance, jurisdictional workers compensation laws, disability systems, and the medical billing process for inpatient / outpatient hospitals and medical providers. 
  • Possess working knowledge of medical, durable medical equipment and home healthcare resources available to the workers' compensation industry.
  • Exhibit well-defined negotiation skills and strong interpersonal skills.
  • Demonstrate evidence of self  motivation and the ability to perform case management duties independently.

 

 



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