Medical Review Nurses - RNs (Miramar, FL)

IntegriGuard has new opportunities for Medical Review Nurses to utilize their skills protecting the Medicare trust fund. The successful individual will perform a clinical review of medical records and/or other documentation to determine the accuracy and appropriateness of billings for provided services; complete medical review summaries to document findings; maintain internal quality control processes to assure the reliability of project reviews; provide support to internal and external customers with respect to clinical and Medicare-related issues; conduct claims research using the appropriate systems; attend on-site visits with investigative team as necessary to retrieve medical records and conduct provider interviews; research policy, regulations, and coverage determinations; and provide a clinical perspective to investigative team during fraud case development.

Position Requirements Include:

• Active RN license in good standing
• Bachelor’s degree in nursing or related field preferred
• Minimum of three years diversified nursing experience providing direct care in an inpatient or outpatient setting
• One or more years experience performing medical records review or utilization review preferred
• Knowledge of the Medicare program preferred, particularly the coverage and payment rules
• Ability to maintain high quality work while meeting strict deadlines
• Excellent written and verbal communication skills
• Not currently sanctioned or excluded from the Medicare program by the OIG

Send your resume to us in one of three ways:

E-mail: humanresources@integriguard.org

Mail:
Human Resources
IntegriGuard
2121 North 117 Avenue, Suite 200
Omaha, NE 68164

Fax: 402.498.2534

IntegriGuard is an Equal Opportunity and Affirmative Action Employer.

Any questions regarding benefits can be directed to: humanresources@integriguard.org