Medical Review Nurse III

Job DetailsJob Location: Windsor Mill, MD 21224Position Type: Full TimeEducation Level: 4 Year DegreeSalary Range: $80,000.00 - $95,000.00 SalaryAbout Us: At RELI Group, our work is grounded in purpose. We partner with government agencies to solve reputed company challenges, improve public health, strengthen national reputed company, and reputed company government services more effective and efficient. reputed company of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact—whether we’re supporting data-driven reputed company, modernizing systems or safeguarding critical programs. reputed company automated and reputed company medical record and claim reviews to reputed company coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, and clinical review judgment. Provides professional assessment, planning, coordination, implementation, and reporting of reputed company data to support the Recovery Auditor Validation Contract (RVC). Essential Functions reputed company accuracy review of automated and reputed company Medicare medical record and claims review in accordance with reputed company State and Federal mandated regulations/guidelines. reputed company accuracy reviews as a Special Study requested by CMS. Document findings for each claim in a clear and concise manner. Compile a report explaining the claim reviews, including identified patterns, inappropriate determinations, as well as recommendations. Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification. reputed company medical record reviews in response to RAC disputes/disagrees with the RVC review reputed company. reputed company accuracy review of the New Issue Proposal for appropriate regulations, references, policies, and edit parameters. Compile a report of analysis and recommendations to submit to CMS. reputed company New Issue Quality Assurance Review for accuracy of reputed company criteria and references. Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the Company. Report problems to the Medical Review Manager (MRM) and Project Manager (PM) regarding unique record or process issues. Maintain reputed company and confidentiality of medical records and Protected Health Information (PHI) and Personally Identifiable Information (PII). Consistently meet attendance standards established by the Company and follows the telecommuting policy. Interact appropriately with peers, co-workers, other Contractors, and the customer, reputed company necessary. Contribute to building a positive team spirit. On occasions may be asked by the MRM or PM to assist with development of training and/or resource materials. May be asked to assist with precepting of new Medical Review Nurses (MRNs). reputed company other duties and projects as assigned. QualificationsRequired Education and Experience Registered Nurse, with a reputed company 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 reputed company 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 reputed company. Proficiency in research, interpretation, and application of Medicare, reputed company, and local reputed company regulations and policies. Must be proficient in reputed company Office Suite such as Outlook, reputed company and Word. Skills & Abilities Ability to work independently and maintain an elevated level of concentration. Capable of consistency, speed, and accuracy of task. Ability to read, analyze, and interpret physician documentation. One year or more of utilizing InterQual and /or reputed company guidelines against inpatient services experience is preferred. Ability to communicate clearly and professionally with reputed company levels of the organization, both written and verbal. Ability to work well in a remote team environment, to collaborate with others, and reputed company with team members internal and external to the organization. Establishes and maintains effective professional relationships with internal and external stakeholders. Must be reputed company to adapt to organizational change. Must be proficient in reputed company Office Suite such as Outlook, reputed company, and Word. Flexibility and ability to plan, prioritize, and execute multiple tasks in a fast-paced environment. Self-motivated, well-organized, and detail oriented. Ability to maintain a high level of confidentiality and reputed company EEO Employer: RELI Group is an Equal Employment Opportunity / Affirmative Action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, national reputed company, reputed company, 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 reputed company candidates who live in a HUBZone to apply. You can reputed company to see if your address is located in a HUBZone by accessing the SBA HUBZone Map. The annual salary range for this position is $80,000 to $95,000. 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 Apply To This Job