Medical Review Nurse - RN Gainesville

Location: Gainesville, FL
Date Posted: 04-21-2017
TDY Medical Staffing, Inc. is currently seeking two Medical Review Nurses for a 24 month contract position located in Gainesville, FL. This is a Monday - Friday Day Shift position. Please do NOT apply if you are not willing to work forty hours per week. Once you apply, please check your email as we will communicate with you via this means. 

Please read everything below before applying and only apply if you are fully qualified.  Preference given to applicants with previous medical review experience. 

MINIMUM REQUIREMENTS
  • Associates OR Bachelor’s Degree.
  • Active RN license
  • 1 Years Clinical Experience
  • BLS/CPR current
  • Strong written and oral communication skills
  • Be able to research medical and health care delivery issues
  • Possess an aptitude for data analysis.
Must have computer experience.  Please submit a resume with 3 professional references - please list your skills online in the area provided after you hit the APPLY button.  If you do not submit a resume with professional references, you will not be considered for employment.

Number of Openings: 8
Start Date: ASAP
Assignment Duration: 12 months
Work Hours: 40 Hours/Week
Does not require travel.
Must be eligible to work in the United States.

Essential Duties & Responsibilities:

Performs medical review of pre and post payment claims.
Identifies providers needing education and individually educates providers who are subject to medical review processes.
Identifies problem providers through data analysis and by monitoring provider reasons for denial through claim review logs, develops and implements corrective action plans designed to ensure the resolution of issues related to coding, documentation and medical necessity/coverage.
  • Make medical review claims adjudication decisions.
  • Review provider practices and identify issues of concern, overpayment and need for corrective action.
  • Develop recommendations for further corrective action based on medical review findings.
  • Implement corrective action related to medical review activities.
  • Performs other duties as the supervisor may, from time to time, deem necessary.

PREFERRED Knowledge, Skill, Education/Training and Experience Requirement.:
Computerized Patient Records System

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

TDY Medical Staffing, Inc. is an Equal Opportunity Employer and takes pride in maintaining a diverse environment.  All qualified applicants will receive consideration for employment without regard to their race, color, religion, gender, gender identity, national origin, age, sexual orientation, marital or protected veteran status, disability, or any other legally protected status.  If you’d like more information about your EEO rights as an applicant under the law, please click here.

Once you hit the “Apply Now” button, you will be directed to enter into your information into our website general application – There will be several questions asked to ensure our Affirmative Action/EEOC compliance. Your participation is voluntary and will have no impact on the interview process. 

TDY is a federal contractor and as such is required to provide self-identification questions regarding  race/gender/disability/veteran status to all qualified applicants.  We offer all applicants the VOLUNTARY opportunity to respond to the questions. 
You are under no obligation to respond to the questions and not answering the questions will have no impact on the application process or hiring decisions.  Your responses are not seen by the hiring authority and have zero impact on our decision making process.  Submitting this general application is not an offer of employment and does not a guarantee that the application process will proceed. 
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