NURSE REVIEWER
PER DIEM: Non-Exempt - FLEXIBLE 20-30 HOURS PER WEEK
Healthcare Quality Strategies, Inc. (HQSI), founded in 1982, is a small, vibrant not-for-profit organization in New Jersey with URAC accreditation as an Independent Review Organization. We are currently searching for several Nurse Reviewers (RN) who will work full time remotely in FL to support our team.
Primary duties include performing medical necessity and policy review for Medicaid claims, hospital systems and commercial payers; RN will work closely with Physician Peer Reviewer and contract team.
Requirements include:
- Active RN licensure in good standing
- Must have internet connection, and private work space; HQSI will provide equipment needed to perform job duties
- Minimum of two years’ experience performing medical record review, audit for federal or state contracts
- Knowledge and experience of Medicare and Medicaid policy (Part A, Part B and DME) a plus
- Medical terminology (familiarity with DRG validation, ICD-10, CPT and HCPCS preferred)
- Current standards of medical practice
- Solid analytical, assessment and communication skills (verbal and written)
- Strong attention to detail
- Strong attention to deadlines
- Computer proficiency (Word and Excel)
- Ability to work independently
Candidates must be based in FL
Physical Demands:
The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
Primary functions require sufficient physical ability and mobility to work in an office setting;
to sit for prolonged periods of time; to occasionally stand, stoop, bend, kneel, crouch, reach, and twist; to operate office equipment requiring repetitive hand movement and fine coordination including use of a computer keyboard and to verbally communicate to exchange information.
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org > Careers > Current Employment Opportunities
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is an Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug-Free Workplace
Healthcare Quality Strategies is an E-Verify employer