Medical Review Nurse - RN (Jacksonville, 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.

Experience/Education/Abilities

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