Medical Review Analyst, Registered Nurse

Job not on LinkedIn

11 hours ago

⚔️ Virginia – Remote

Although this job is listed in Virginia, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Integrity Management Services, Inc.

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Compliance • Government • Recruitment

Integrity Management Services, Inc. is a women-owned, women-run company specializing in helping government and commercial enterprises minimize the risk of improper payments, fraud, waste, and abuse. The company provides a range of services including data analytics, fraud investigations, compliance reviews, audits, grants management, staff augmentation, and coding and medical reviews. IntegrityM, as they are known, works closely with Federal Government agencies, state agencies, and private sector organizations to drive informed decisions and enhance program transparency and oversight. The company is recognized for its contributions to the community and has been awarded for excellence in government contracting and corporate social responsibility.

51 - 200 employees

📋 Compliance

🏛️ Government

🎯 Recruiter

📋 Description

• Conduct medical record reviews and apply sound clinical judgment to claim payment decisions • Additional research on medical claims data and other sources of information to identify problems • Review sophisticated data model output • Utilize a variety of tools to detect situations of potential fraud • Support ongoing fraud investigations and requests for information • Research national and local policy as well as Medicare and/or Medicaid guidelines for supporting references in review determinations • Conduct reviews under the guidance of a Medical Review Manager/supervisor

🎯 Requirements

• Current/active RN license • 5-7 years of experience in the medical field as a Registered Nurse or other clinician • Experience in review of medical claims for coverage and medical necessity • Strong investigative skills • Demonstrated proficiency in Medical Review work • Working knowledge of Medicare and Medicaid • Excellent communication skills • Demonstrated prioritization, problem solving, and organization skills • Strong computer skills including Microsoft Office proficiency • All candidates MUST pass a background check and drug screening prior to employment • **Preference:** • Bachelors in of Science in Nursing (BSN) • 2+ years’ clinical experience • Coding certificate • Enthusiastic individuals who can work effectively in a dynamic environment both in a team as well as independently is a must!