Description: Judge Healthcare is seeking Registered Nurses for a Fully Remote Medical Review RN position for one of our biggest clients!
Job Title: Medical Review RN Contract Duration: Approximately 6 months Work Schedule: Monday to Friday, 8 hours per day (start time between 7 AM - 8 AM EST) Preferred Locations: NJ, PA, NY, DE, or CT Pay: $33-34/hr
Job Responsibilities:
Assess patients' clinical needs against established guidelines to ensure appropriate inpatient care and length of stay.
Evaluate the necessity, appropriateness, and efficiency of medical services and procedures.
Coordinate and assist in the implementation of care plans for members.
Monitor and coordinate services rendered outside the network and negotiate fees as appropriate.
Coordinate with patients, families, physicians, hospitals, and other external customers to ensure appropriate care from diagnosis to outcome.
Deliver high-quality, cost-effective care supported by clinical practice guidelines.
Monitor patients' medical care activities and outcomes for appropriateness and effectiveness.
Advocate for members and families to coordinate resource utilization and service evaluation.
Encourage member participation and compliance in case/disease management programs.
Document accurately and comprehensively based on standards of practice and organizational policies.
Communicate with multidisciplinary teams to ensure continuity and efficiency of care.
Understand fiscal accountability and its impact on resource utilization and self-care outcomes.
Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.
Complete other assigned functions as requested by management.
Requirements:
Active NJ or Compact RN license
Medical policy review and claims experience
Minimum of 3 years of RN experience in a clinical setting
Health insurance experience
Proficiency with Microsoft Office Suite
Are you or someone you know interested? Reach out to Britney Bishop with an updated resume to bbishop@judge.com for immediate consideration!
Contact: bbishop@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
