Medical Review Nurse
Requirements of the Medical Review Nurse
- Active Florida Nursing License with two (2) years of related work experience
- Must have previous medical record / quality review experience; HEDIS/STARS preferred
- Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills
- Ability to communicate clearly verbally and in writing
- Organizational skills are very important; must be able to work independently to complete tasks with minimal direction.
- Open to both LPN’s and RN’s
Benefits of the Medical Review Nurse
- $25-$32 per hour, depending on experience
- Flexible Hours
- Full time hours, 6 Month+ Contract
- Medical / Dental / Vision
Responsibilities of the Medical Review Nurse
- Preferred experience:
- Disease management experience is helpful
- Recent experience in medical record reviews, data collection for HEDIS / Stars
- Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team.
- Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed. Maintain organized, updated reporting of activities with clear documentation. Required to track, monitor and report on the status of records and volume of work.
- Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports.
If you believe that your skills and experience are a match for this position, please submit your most current resume and a recruiter will be in contact.