Remote Per Diem Nurse (RN) – New Jersey
- Clinical License RN
- State(s) NJ
Job Description Summary
This is an evergreen/continuous posting for future Per Diem Nurse roles within CCC. Please know you may not be contacted immediately but when we have an available position open, we will be reviewing candidates who have applied to this posting.
Daily assignment will be made based on production / staffing need, assignment will include but not be limited to;
- Perform utilization review per regulatory and client directed criteria
- Determine if requested (Prospective) or completed services (Retrospective) require physician review for level of care issues, causality or medical necessity
- Quality Assurance of Physician Letter Reports
- Determine if CPT codes reviewed are supported by documentation provided and eligible for reimbursement per guidelines
- Completion of Desk and/or Onsite Audits of facility / provider billing submission
- File review summaries
- Independent Medical Examination/Peer Review/Physician Advisor referrals
- Telephonic support for Adjusters, Internal/External Counsel, and other operational personnel
- Other duties as assigned
- Registered Nurse (RN)
- Must possess an active, unencumbered license in state of residence and the State of New Jersey.
- Required to become CHCQM certified by the ABQAURP within one year of hire.
Job Related Skills/Experience:
- 2-3 years previous case management/ UR experience with strong clinical back ground
- Minimum 1-year prior case management experience dealing with Auto PIP, Worker’s Compensation, managed care, home care or rehabilitation preferred
- Knowledge of CPT, ICD and NDC codes, NCCI Edits, AMA and AAOS guidelines
- Multi State Knowledge of Regulations a plus
- Ability to handle multiple tasks
- Ability to work under moderate supervision
- Strong problem solving, critical thinking and interpersonal skills
- Excellent written and verbal communication skills
- Knowledge of computers, Excel, Word and Windows
This position is a Field (Remote-work from home) opportunity. Requires broadband internet access such as cable or Verizon FIOS – DSL and Satellite are not acceptable.
THIS POSITION IS NOT BENEFITS ELIGIBLE