Job Overview
Join our dynamic team as an MSA Nurse Reviewer, where compassion meets meticulous detail in the healthcare sector. This remote role calls for experienced Medical Analysts skilled in preparing Medicare Set-Asides and Medical Cost Projections. You will be entrusted with reviewing medical records, crafting comprehensive narratives, and allocating costs for medical treatments and prescription medications. A profound understanding of CMS policies concerning MSAs is essential, along with strong writing and analytical skills. Collaborating closely with attorneys and medical professionals, you will play a critical role in developing Medicare Set-Asides and Medical Cost Projections.
Key Responsibilities
- Review pertinent medical documentation to deliver thorough narratives and cost projections for future treatments related to Workers' Compensation and Liability injuries, ensuring adherence to the latest guidelines.
- Work collaboratively with a team of legal and medical experts to delineate, negotiate, and document treatment guidelines and explore potential cost reductions.
- Leverage advanced technology tools to analyze diagnoses, treatment protocols, and prescription pricing, documenting your findings meticulously.
- Provide additional insights and medical recommendations as required to enhance patient care.
- Identify cost drivers and savings opportunities across all cases, engaging in client-specific cost mitigation initiatives as necessary.
- This full-time position may offer additional hours during peak periods, with occasional travel (less than 10% of the time) required.
Required Skills
- Strong comprehension of CMS policies regarding MSAs.
- Proficiency in both written and oral communication, with a proven ability to prepare comprehensive reports.
- Ability to work autonomously as well as collaboratively within a team setting.
- Skilled in gathering and synthesizing medical data, claims payment histories, and billing information to ascertain service utilization levels.
Qualifications
- A Bachelor's Degree, Associate Degree, or Diploma in Nursing is mandatory.
- Preferred 3-5 years of nursing experience.
- A valid Registered Nurse (RN) license in good standing is required.
- Experience in drafting medical review reports, conducting medical bill reviews, and carrying out utilization reviews in injury cases is advantageous.
- Preferred certifications include Medicare Set-Aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), and others related to medical coding and legal nurse consulting.
Career Growth Opportunities
Join a company that has consistently led the insurance industry in data analytics and technology for over 50 years. We offer a platform for you to voice your ideas and develop a fulfilling career that highlights your unique skills. Benefit from flexible work arrangements, comprehensive support, coaching, and training designed to help you excel.
Company Culture and Values
We pride ourselves on our stellar workplace culture, having been recognized as a Great Place to Work® in the U.S. for eight consecutive years, and celebrated globally for our commitment to inclusivity and diversity. Become part of a vibrant community of 7,000 individuals dedicated to ethical innovation and the transformative power of big data, working together to create a brighter future.
Employment Type: Full-Time