Please note that this position is
no longer available.
If you would like to be considered for similar opportunities now or in the future, feel free to apply and/or set up a notifier for yourself.
Medical Reivew Nurse
TX - Irving
We currently have multiple openings for: Medical Review Nurse Current opportunity for a Medical Review Nurse to provide medical records review of files as requested. The successful individual will perform a clinical review of medical records and/or other documentation to determine correct coding, medical necessity and that services paid by the Medicaid agency is supported and appropriate; complete medical review form, accurately documenting findings, and provide policy/regulatory support for determination; maintain internal quality control processes to assure the reliability of project reviews; develop and maintain documentation on quality improvement processes; provide support to internal staff, subcontractors and providers with respect to Medicaid related issues; conduct claims research using the appropriate systems; attend on-site visits to retrieve medical records and conduct provider entrance and exit conferences; serve as mentor and trainer to LPN reviewers and coders. Requirements for this position: Registered nurse with license in good standing is required. Minimum of three years health care work in a provider organization. One or more years experience performing medical records review or utilization review preferred. Ability to maintain high quality work while meeting strict deadlines. Knowledge Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements. General writing skills and ability to produce work free from typographical or spelling errors. Working knowledge of Microsoft Office, Internet and e-mail. Shows longevity in employment with one or more past employers. Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid. Ability to travel up to 35% is required.
We currently have multiple openings for: Medical Review Nurse Current opportunity for a Medical Review Nurse to provide medical records review of files as requested. The successful individual will perform a clinical review of medical records and/or other documentation to determine correct coding, medical necessity and that services paid by the Medicaid agency is supported and appropriate; complete medical review form, accurately documenting findings, and provide policy/regulatory support for determination; maintain internal quality control processes to assure the reliability of project reviews; develop and maintain documentation on quality improvement processes; provide support to internal staff, subcontractors and providers with respect to Medicaid related issues; conduct claims research using the appropriate systems; attend on-site visits to retrieve medical records and conduct provider entrance and exit conferences; serve as mentor and trainer to LPN reviewers and coders. Requirements for this position: Registered nurse with license in good standing is required. Minimum of three years health care work in a provider organization. One or more years experience performing medical records review or utilization review preferred. Ability to maintain high quality work while meeting strict deadlines. Knowledge Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements. General writing skills and ability to produce work free from typographical or spelling errors. Working knowledge of Microsoft Office, Internet and e-mail. Shows longevity in employment with one or more past employers. Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid. Ability to travel up to 35% is required.
HMS is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
