RN - Medical Allocator I

CorVel • West Des Moines, IA

243d • $51,807 - $83,551 • Remote

About The Position

The Medical Allocator creates a cost projection of a patient's medical treatment needs by reviewing medical records and identifying a pattern of care. The medical cost projection, also known as a Medicare Set-Aside (MSA) report, is part of a workers' compensation or liability claim settlement. The Medical Allocator will rely on their medical knowledge and guidelines provided by the Centers for Medicare and Medicaid Services (CMS) to evaluate the patient's treatment plan for future medical treatment needs. Work from home possible.

Requirements

• Graduate of accredited school of nursing, BSN desirable
• Current RN Licensure in state of operation
• 3 or more years' of recent clinical experience, preferably in rehabilitation
• Certification as a MSCC, CLCP, or CNLCP preferred
• ICHCC approved course in Medicare Set-Aside completion within 3 months of hire date required
• Successfully pass ICHCC Medicare Set-Aside Consultant examination within 4 months of hire date
• Strong clinical background in orthopedics, neurology, or rehabilitation preferred
• Strong cost containment background, such as utilization review or managed care helpful

Responsibilities

• Collaboration with the claim adjuster
• Review medical records to prepare a Medicare Set-Aside allocation (MSA) report
• Perform evidenced based medical research
• Utilize medical knowledge to outline the patient's medical treatment
• Assign pricing to medical treatment allocations
• Assign pricing to medication allocations
• Prepare submission of MSA report to CMS for review and approval
• Secure, review, and dispute Medicare conditional payments unrelated to claim/s in settlement process
• Required to read extensively
• Required to prepare organized reports within a specified timeframe
• Required to use computer extensively
• Requires regular and consistent attendance
• Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
• Additional duties as required

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees