Precertification Nurse (Remote - East coast)

MEDLOGIX, LLC•Hamilton Township, NJ

1d•Remote

About The Position

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.

Requirements

3 Years Med-Surg
Active Nursing License in good standing – LPN/RN
Graduate of an accredited school of nursing
New Jersey Auto PIP / No-Fault
InterQual/Review Manager/CERME
CPT and ICD-9/ICD-10 diagnosis coding
Medical management related to auto claims
Microsoft Office Suite programs
Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
Strong interpersonal skills, communication and presentation
Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes
Ability to work independently
Ability to provide instruction and direction to support staff
Will be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing laws
Must be detail oriented and able to multi-task
Must be able to type 45-50 words per minute