Utilization Nurse

Recruit Up, LLC
Norwood, MA
Sep 29, 2017
Jobs Outside Higher Education
Other Jobs Outside Higher Education
Institution Type
Outside Academe

Job Description

BSN Degree or equivalent, as well as a minimum of two years clinical or related field experience, or equivalent combination of education and experience is required for this position.

Our client is a industry leading provider of independent medical examinations (IME), peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. They provide IME services through a medical panel of credentialed physicians and allied medical professionals. Working for our client gives you the opportunity to be part of a growing business that is focused on driving customer satisfaction. We'd like to offer you the opportunity to grow in your career as the organization grows, comprehensive benefits package, ability to work from home, competitive pay scale, 401K and a fulfilling career where you can relate to and engage with an incredible team!

Due to substantial growth, our client is seeking to hire several RN Quality Assurance Coordinators for their Boston, MA location. This position will be responsible to ensure Peer Review case reports are completed at the highest level of quality and integrity as well as in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates.

Education and/or experience:
BSN or equivalent is required, along with a minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.

Essential Duties:
  • Performs quality assurance review of IME reports, correspondences, addendums or supplemental reviews.
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
  • Ensures the provider credentials and signature are adhered to the final report.
  • Identifies any inconsistencies within the report and contacts the Provider to obtain clarification, modification or correction as needed.

  • Have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals, as well as ability to compute rates and percentages.
  • Qualified typist with a minimum of 40 W.P.M preferred.
  • Ability to operate a general computer, fax, copier, scanner, and telephone.
  • Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Must possess excellent skills in English usage, grammar, punctuation and style.
  • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
  • Ability to work independently, prioritize work activities and use time efficiently, maintain confidentiality, work well under pressure and stressful conditions.

**Once fully trained, MES offers the flexibility to work from home three days a week**

Company Description
Humans with Resources: That's us! We know the recruiting business inside and out and relish in employing that knowledge for the benefit of our clients and candidates.

Recruiting. Where's the enjoyment in that? You found it right here at Recruit Up.

Who are we exactly? You can read those details throughout our website, but the bottom line is we are seriously intent on helping our clients grow both literally and figuratively. We have experience, insight and intuition that we put to work for organizations across the country, and have fun doing it along the way. After all, there is a Human side to our Resources.

We are an RPO Firm who works in partnership with organizations that have found their own unique space in the market. That's a good thing, but sometimes it can pose a challenge to finding just the right person, or mix of people, who will be active contributors and help drive the strategy forward.

For those looking for a hand in growing their team, there are advantages to doing business with partners who complement their own strengths and assets. That's where Recruit Up comes in.

Geared up for growth? Let's get started.

Norwood, MA


Wed, 27 Sep 2017 06:50:29 PDT