Kelly Healthcare Resources
Current Needs:Currently seeking a Medical Review Registered Nurse in Baton Rouge, Louisiana. This is a full time, temporary position.
Position Description:
* Reviews medical claims or request for services and applies medical judgment and /or criteria in determining the benefits for pre-services and post-services according to contractual benefits and limitations, ie. pre-existing, workman compensation, riders, contractual exclusions, cosmetic procedures and medical necessity to ensure the proper administration of contractual and medical limitations/exclusions.
* Prepares documentation of medical information, completes research, makes recommendations and refers potential denials when necessary to ensure compliance with standards, laws and regulations.
* Enters all cases correctly in the appropriate computer system to ensure appropriate data retention and claims adjudication.
* Completes correspondence correctly when necessary, to providers and subscribers to ensure that customers are aware of the determinations and appeal processes/rights meeting all regulatory standards.
* Utilizes appropriate professional nursing judgment in application of contractual benefits and limitations, administrative directives, and claims policy.
Job Requirements:
* Must be a Registered Nurse with a current Louisiana license.
* Bachelor degree in nursing required.
* At least 3 years of direct patient care/clinical experience required.
* At least 2 years managed care experience strongly preferred.
* Certification in Professional Coding or an additional certification in one of the following preferred or attained within 24 months after date of hire: Utilization Review, Utilization Management, Quality Review, Case Management or Chronic Disease Management, or HIAA.
* Knowledge of coding guidelines for ICD-9, HCPCS, and CPT preferred.
* Must have ability to critically evaluate clinical, claim and benefit information and make independent decisions and anticipating impacts and needs utilizing appropriate professional judgment.
* Proficiency in use of standardized data exchange code sets and medical terminology preferred.
In addition to working with the worlds most recognized and trusted name in staffing, Kelly employees can participate in the following benefits:
* Highly competitive pay
* Access to eLearning
About Kelly Services®
Kelly Services, Inc. (NASDAQ: KELYA, KELYB) is a leader in providing workforce solutions.
Kelly®offers a comprehensive array of outsourcing and consulting services as well as world-class
staffing on a temporary, temporary-to-hire, and direct-hire basis.
Serving clients around the globe, Kelly provides employment to more than 560,000 employees annually.
Revenue in 2012 was $5.5 billion.
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Our healthcare specialty places professionals across all levels of healthcare in multiple disciplines, including medical laboratory, medical device, pharmacy and pharmacology, nursing, allied health, behavioral health, healthcare billing/coding, utilization, case management, occupational health, special education, and physical therapy.
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