Precertification Nurse-LPN/RN (Remote in NJ/PA)
About The Position
The role of Precertification Nurse is to perform Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries. 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.
Requirements
- Graduate of an accredited school of nursing
- Active New Jersey State Nursing License in good standing – LPN/RN
- 3 Years Med-Surg experience
- Knowledge of InterQual/Review Manager/CERME
- Knowledge of CPT and ICD-9/ICD-10 diagnosis coding
- Knowledge of Microsoft Office Suite programs
- Knowledge of the 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
- Must be detail oriented and able to multi-task
- Must be able to type 45-50 words per minute
Nice To Haves
- Knowledge of New Jersey Auto PIP / No-Fault
- Knowledge of medical management related to auto claims
- Utilization Review experience
- Ortho/Rehab experience
Responsibilities
- Perform Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries.
- Educate patients and the provider community regarding the Pre-Certification process and its governing laws.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
