Precertification Nurse (Remote - East coast)
About MedlogixMedlogix, 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:New Jersey Auto PIP / No-Fault - PreferredInterQual/Review Manager/CERMECPT and ICD-9/ICD-10 diagnosis codingMedical management related to auto claims – PreferredMicrosoft Office Suite programsStructure and content of the English language including the meaning and spelling of words, rules of composition and grammarSkills:Strong interpersonal skills, communication and presentationAbility to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomesAbility to work independentlyAbility to provide instruction and direction to support staffWill be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing lawsMust be detail oriented and able to multi-taskMust be able to type 45-50 words per minuteExperience:3 Years Med-Surg – RequiredUtilization Review – PreferredOrtho/Rehab – PreferredJob Type: Full Time; home basedRequired Education:Graduate of an accredited school of nursingRequired License or certification:Active Nursing License in good standing – LPN/RN
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