Note these job openings:
- Beneficiary Protection Review Coordinator
(Quality Insights of Pennsylvania, Harrisburg, PA) Performs administrative and professional work associated with individual case review and coordinates reconsideration of contested denials of medical necessity of Medicare contract cases. Qualifications: Minimum Educational Requirements: Successful completion of a diploma nursing program, an associate degree in nursing from an accredited college or university or a BSN from an accredited four-year college or university. Experience and Skill Requirements: Two years of full-time or equivalent part-time paid clinical experience as a registered professional nurse in the acute care setting for associate-degree or diploma nurse. A minimum of one year of full-time or equivalent part-time experience for a baccalaureate degree. Previous utilization review experience desired but not mandatory. Special Requirement: Current license, temporary permit or eligibility for endorsement to practice as a registered professional nurse in the state of Pennsylvania.
- Nurse Reviewer (Diagnostic Imaging and other areas of review, as needed)
(WVMI, Charleston, WV) To provide efficient, timely and objective non-physician review services for Medicaid beneficiaries needing diagnostic imaging services, in accordance with the WVMI prior-authorization review plan and as specified in accordance with policies and standards of the Bureau of Medical Services (BMS). Also will be expected to cross-train in other areas of review, as needed. Qualifications: Educational Requirements: Successful completion of a diploma nursing program, or an associate degree in nursing from an accredited college or university, or a baccalaureate degree in nursing from an accredited four-year college or university. Experience: Two years of full-time or equivalent part-time paid clinical experience as a registered professional nurse in the acute care setting for diploma or associate degree. A minimum of one year of full-time or equivalent part-time paid clinical experience for a baccalaureate degree. Previous imaging review experience desired but not mandatory. Special Requirement: Current license or temporary permit to practice as a professional registered nurse in the state of West Virginia.
- Data Manager
(Quality Insights Renal Network 3, Cranbury, NJ) Responsible for all technology-related aspects of QIRN3. Primary duties include, but are not limited to, developing data analysis and statistical reports, participating in the validation, testing and design of special programs to implement federal directives, assuring confidentiality and security of patient data, maintenance of computer systems and peripherals, and overseeing data entry of patient and facility data. The data manager also serves as an information technology resource to facilities, coworkers and federal contacts. Education: A baccalaureate degree from an accredited four-year college or university in computer information systems or other relevant discipline is required. A master’s degree is preferred. Experience: Must have at least five (5) years of experience in a comparable position, experience with SQL Server and familiarity with Oracle databases. Special Requirements: Windows and MS Office expertise required, as well as a background in statistics and analytics. Must present documented evidence of success working collectively with non-technical entities and possessing excellent writing and presentation skills.
- PAS Field Nurses
(WVMI, WV) Conduct in-home medical necessity reviews to support the West Virginia Bureau for Medical Services' Aged and Disabled Waiver Program. Regional travel is required. Clinical experience in the areas of home health, rehabilitation and/or skilled nursing care preferred. These positions are home-based and require excellent clinical assessment, documentation and communication skills and familiarity with computer technology. For information on available openings, please contact WVMI Human Resources at 1-800-642-8686, ext. 4225.
- RN, RHIA, RHIT Independent Contractors (nationwide)
WVMI needs RNs, RHIAs, or RHITs as independent contractors for data abstraction in hospitals and outpatient clinics around the United States. Travel may be possible, or you may stay in your local area. Utilization review and computer experience are a plus.
