Nurse Reviewer (RN) - Wayne, PA

GENEX Services, Inc. (www.genexservices.com) is the premier provider of cost-containment and fully integrated care management services in the occupational, auto and group healthcare markets. Our 2,200 medical and business professionals provide comprehensive care solutions to more than 1,200 clients from 120 locations throughout the United States, Puerto Rico and Canada.

 

We are currently seeking a Nurse Reviewer (RN) to work in our Utilization Management office located in Wayne, PA.

 

RESPONSIBILITIES: Responsible for the performance of utilization review services, including pre-admission certification, second surgical opinion, concurrent utilization review and DRG validation. Interfaces with external agencies/ representatives relative to the utilization review process including, but not limited to, third-party payers, insurance companies and providers. Responsible for accurate completion of case data in the Managed Care system, as well as the accurate and timely generation of required correspondence/review notification. Reports  potential problems identified during reviews or data collection (i.e. questions regarding medical criteria) to management. Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.

 

REQUIREMENTS: Diploma, Associate or Bachelors Degree in Nursing required.  Advanced Degree preferred.  Registered nurse with current, valid state licensure required. A minimum of 3-5 years general nursing practice or workers’ compensation-related experience required. Prior Utilization Review experience and certification preferred.  Excellent interpersonal skills, phone manners and organizational skills are essential.  Must be proficient in Microsoft Office suite with such programs as Word and Excel as well as have experience with internet searches and a comfort level with other software programs. Ability to set priorities and work independently is essential.  Spanish speaking ability a plus!

 

GENEX offers a comprehensive compensation and benefits program including a competitive salary, medical, dental, life and LTD insurance, 401 (k) with company match and 100% vesting after 90 days of employment, and a Continuing Education Program accredited by CCM, CRC and CDMS.

 

Please apply using the URL link below or click on ‘Apply Online’. You can also send your resume to hr@genexservices.com or fax to 877-463-3838.

 

Please reference Job:3280 when applying. The final date to apply is May 2008. EOE M/F/D/V

  http://jobs-genexservices.icims.com/genexservices_jobs/jobs/candidate/job.jsp?jobid=3280&mode=view