MSA Nurse Reviewer

Verisk Analytics • Woburn, MA

2d

About The Position

We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications. Candidates will demonstrate knowledge of CMS policies related to preparing MSAs. Strong writing skills, analysis skills and application of guidelines are required for this position. Medical Analysts will work closely with our attorneys and other members of the medical team to prepare Medicare Set-Asides and Medical Cost Projections.

Requirements

• Bachelor’s Degree, Associate Degree or Diploma in Nursing required
• 3-5 years’ experience in Nursing preferred
• Registered Nurse (RN) license in good standing with applicable Board of Nursing required
• Experience in preparing medical review reports, medical bill reviews and utilization reviews in injury cases preferred
• Strong interpersonal, oral, and written communication skills including report preparation preferred
• Ability to work effectively both independently and as a member of a team
• Ability to gather data, compile and synthesize information, including medical information, claims payment histories and billing, to identify level and types of services utilization

Nice To Haves

• Certification in any of the following preferred: Medicare Set-aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), Medical Coding, Legal Nurse Consulting, Rehabilitation Counseling, Disability Management, Utilization Review

Responsibilities

• Through a review of relevant medical files and related documentation, provides a narrative and cost projection for future treatment related to Workers Compensation and Liability injuries consistent with the current guidelines
• Collaborates with a team of attorneys and medical professionals in identifying negotiating, and documenting guidelines and cost reductions on future treatment plans
• Uses ISO Claims Partners proprietary information technology tools to identify diagnoses, treatment guidelines, and prescription medication pricing, and documents the case when applicable
• Provides additional analysis and medical recommendations as needed
• Identifies cost drivers and cost savings opportunities on all files and completes client specific-cost mitigation activities on files where applicable

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees