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MEDLOGIX, LLC logo
MEDLOGIX, LLC

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

Precertification Nurse

Location

United States

Posted

91 days ago

Salary

$28 - $32 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Precertification Nurse

MEDLOGIX, LLC

Role Description The role of Precertification Nurse is to perform Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries. Qualifications - New Jersey Auto PIP / No-Fault - Preferred - InterQual/Review Manager/CERME - CPT and ICD-9/ICD-10 diagnosis coding - Medical management related to auto claims – Preferred - Microsoft Office Suite programs - Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar Requirements - Strong interpersonal skills, communication and presentation - Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes - Ability to work independently - Ability to provide instruction and direction to support staff - Will be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing laws - Must be detail oriented and able to multi-task - Must be able to type 45-50 words per minute Experience - 3 Years Med-Surg – Required - Utilization Review – Preferred - Ortho/Rehab – Preferred Job Type - Full Time; home based Required Education - Graduate of an accredited school of nursing Required License or certification - Active Nursing License in good standing – LPN/RN

Job Requirements

  • New Jersey Auto PIP / No-Fault - Preferred
  • InterQual/Review Manager/CERME
  • CPT and ICD-9/ICD-10 diagnosis coding
  • Medical management related to auto claims – Preferred
  • Microsoft Office Suite programs
  • Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
  • Strong interpersonal skills, communication and presentation
  • Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes
  • Ability to work independently
  • Ability to provide instruction and direction to support staff
  • Will be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing laws
  • Must be detail oriented and able to multi-task
  • Must be able to type 45-50 words per minute
  • Experience
  • 3 Years Med-Surg – Required
  • Utilization Review – Preferred
  • Ortho/Rehab – Preferred
  • Job Type
  • Full Time; home based
  • Required Education
  • Graduate of an accredited school of nursing
  • Required License or certification
  • Active Nursing License in good standing – LPN/RN

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