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RN / Florida / Permanent / Clinical Medicaid Review Nurse Job

Company: HCA.
Location: Fort Pierce
Posted on: March 17, 2020

Job Description:

Description SHIFT: Work From Home

SCHEDULE: Full-time

Are you looking for a work environment where diversity and inclusion thrive? Submit your application with HCA Healthcare today and find out what it truly means to be a part of a team.
We are committed to providing our colleagues with the support they need. We offer an array of medical, dental, and vision packages as well as several add-on perks to make your benefits package truly customizable to you. Some of our unique benefits we offer include:
Student Loan Repayment Program Tuition Reimbursement/Assistance Programs
Moving, mortgage, and real estate assistance
100% matching 401k based on years of service
Identity Theft Protection discounts
Auto, Home, and Life Insurance options
Adoption Assistance
Employee Stock Purchase Program (ESPP) We value your contributions. Our employee recognition programs encourage our teams to raise the bar. Come be a part of the change! The Clinical Medicaid Review Nurse WORK FROM HOME is responsible for handling all retrospective reviews for the Florida Medicaid accounts that require clinical input or interpretation. This includes but is not limited to Undocumented Non-Citizen Reviews (Alien) and BBA accounts. In this role you will: Review accounts in Artiva, eRequest and eQsuite for verification and identify that a medical necessity review is needed. Review the clinical information and complete the review process in eQsuite to obtain an authorization Apply appropriate Inpatient or Outpatient criteria to include InterQual or any proprietary criteria sets Document the review in eQsuite and attach necessary medical clinical supporting documentation as applicable Notate all accounts in Artiva and eRequest for all activities and communications utilizing correct spelling and grammar including possible outcomes such as possible denial with the correct rationale Respond to requests for pended, denied, partially denied, and reconsideration reviews as needed Maintain excellent communication with all internal and external clients Complete MMA BBA clinical appeal form letters by reviewing the clinical information needed to compose the medical necessity summary Request medical records or any additional supporting documentation necessary to perform a review as needed Qualifications Education Associates degree in healthcare related field accepted. Bachelors or Masters degree preferred Maintains all credentialing applicable to their state licensure Experience Minimal 3 years clinical experience in healthcare setting; hospital setting preferred. Case management and/or coding experience preferred. Utilization Review experience helpful. Certificate/Licensure Current licensure in Florida in healthcare related field RN preferred, LPN accepted Parallon is an industry leader in revenue cycle services. We partner with over 650 hospitals and 2,400 physician practices nation-wide. Our parent company, HCA Healthcare has been consistently named a Worlds Most Ethical Company by Ethisphere and is ranked in the Fortune 100. We are dedicated to ensuring our patients have the best experience even after they leave our facilities.

HCA Healthcare is dedicated to the growth and development of our colleagues. We will provide you the tools and resources you need to succeed in our organization. We are actively reviewing applications. Highly qualified candidates will be promptly contacted for interviews. Submit your application and help us raise the bar in patient care!
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. #ParallonBCOM

Keywords: HCA., Fort Pierce , RN / Florida / Permanent / Clinical Medicaid Review Nurse Job, Healthcare , Fort Pierce, Florida

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