Utilization Review Nurse Auditor Job in Raleigh 27601, North Carolina US

Responsibilities

inVentiv Medical Management is currently engaged with a healthcare organization in regards to a federal government program for recovery audits as part of the new healthcare package. This program will employ, Recover Audit Contractors (RACs), to detect and correct past improper payments. The RACs will do Medicare claim reviews to ensure the site of service is at the appropriate level/place.

This position will require you to apply medical necessity guidelines based on appropriate criteria and maintain standards set for medical records review.


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Job Qualifications:

·         Registered Nurse with active licensure

·         ADN required, BSN preferred

·         Minimum three years clinical experience required in ICU, ER or Med-Surge

·         Minimum of three years of utilization management experience required

·         Experience with Interqual and/or Milliman

·         Excellent written (to include report writing) and verbal communication skills

·         Knowledge of medical coding (CPT, ICD-9, HCPS) and reimbursement guidelines preferred

·         Direct experience in medical chart review for inpatient providers preferred

·         Experience in Medicare and commercial insurance environment preferred

·         Strong knowledge of HIPAA laws and requirements preferred

·         Proficient typist with strong knowledge of computer applications to include Microsoft Office

·         Ability to multi-task

·         Ability to resolve problems

·         Strong attention to detail

·         Stress tolerant

·         Sound Nursing judgment skills

·         Self-motivated, with ability to work well independently, as well as with team members  

  Additional Requirements:

Benefits: At inVentiv health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality of life balance:                                                                                                                                                                                            

 EOE: inVentiv health its Clients are equal opportunity employers and are committed to employing a diverse workforce.