Medical Review Nurse III

Responsibilities

• Perform medical chart reviews of automated and complex medical record and claims review in accordance with all Federal regulations and guidelines
• Perform accuracy reviews as a special study requested by CMS
• Compile a report of analysis and recommendations to submit to CMS
• Perform accuracy review of medical record and claims review and assess investigative and medical review findings and or other claims data to determine patterns and detect potential fraud waste and abuse
• May handle more complex reviews and audits

Requirements

• Registered Nurse, with a current unobstructed license to practice nursing in the United States.
• Graduate of a Board approved Registered Nursing program
• A Bachelor’s Degree in Nursing (BSN) or other related field is preferred
• Certification in coding highly preferred
• A minimum of three (3) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice
• A minimum of three (3) or more years’ experience in medical/utilization medical record review particularly with Medicare and/or Medicaid
• Proficiency in research, interpretation, and application of Medicare, Medicaid, and local healthcare regulations and policies
• Must be proficient in Microsoft Office Suite such as Outlook, Excel and Word

EEO Employer:

RELI Group is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone:

We encourage all candidates who live in a HUBZone to apply.  You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map.

The annual salary range for this position is $75,000.00 to $95,000.00. Actual compensation will depend on a range of factors, including but not limited to the individual’s skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here