Precertification Nurse-LPN/RN (Remote in NJ/PA)

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.

Overview

The role of Precertification Nurse is to perform Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries.

Full time: Monday to Friday

Location: Remote. Will need to be in Hamilton NJ office for training

Knowledge

1. New Jersey Auto PIP / No-Fault - Preferred
2. InterQual/Review Manager/CERME
3. CPT and ICD-9/ICD-10 diagnosis coding
4. Medical management related to auto claims – Preferred
5. Microsoft Office Suite programs
6. Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar

Skills

1. Strong interpersonal skills, communication and presentation
2. Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes
3. Ability to work independently
4. Ability to provide instruction and direction to support staff
5. Will be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing laws
6. Must be detail oriented and able to multi-task
7. Must be able to type 45-50 words per minute

Experience

1. 3 Years Med-Surg – Required
2. Utilization Review – Preferred
3. Ortho/Rehab – Preferred

Required Education

1. Graduate of an accredited school of nursing

Required License or certification

1. Active New Jersey State Nursing License in good standing – LPN/RN

EEOC STATEMENT

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.

Active New Jersey LPN/RN license, graduate of accredited nursing school, 3 years med-surg experience, typing 45-50 wpm, Microsoft Office proficiency, knowledge of CPT/ICD coding and English language.

Key Responsibilities

• performing precertification
• determining medical necessity
• educating patients

Skills & Tools

InterQual, Review Manager, CERME, Microsoft Office

Job Details

• Category: Healthcare Services - Nursing
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — New Jersey or Pennsylvania or Hamilton
• Salary: USD 74,880 – 74,880 / year
• Languages: English

About Medlogix

A medical claims solutions company providing precertification and utilization review services for insurance carriers. — Industry: Healthcare