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RN Medical Review #686 · Meridian, ID
POSITION PURPOSE:
Under limited supervision, support the medical and quality management initiatives through the appropriate payment of claims, inquiries and appeals for all product lines.
MINIMUM POSITION REQUIREMENTS:
Required Experience:
* Five years acute medical surgical nursing
* One year of physician procedural coding and/or inpatient and outpatient commercial and Medicare coding
* One year utilization management experience including medical necessity determination and discharge planning
Required Certifications/Licenses:
* Valid Idaho Registered Nurse License
Required Knowledge, Skills and Abilities KSAs :
Knowledge of:
* Group process and team dynamics
* Department policy and procedures
* CPT, HCPCS and ICD-9 coding
Skills:
* Strong verbal and written communication
* Excellent interpersonal
* Coaching
* Facilitation
* Analytical
* Problem solving
* Microsoft Word - Basic
* Microsoft Outlook - Basic
Ability to:
* Schedule time effectively
* Handle multiple projects simultaneously and prioritize work appropriately
* Work well in a highly integrated team environment
* Communicate with diverse audiences
PREFERRED QUALIFICATIONS:
* Bachelor's degree in Nursing
* Certified...
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