Medical Review Nurse

**PLEASE APPLY TO THIS POSITION AT WWW.FCSO.COM***

The primary business of First Coast Service Options, Inc., is administering programs that serve Medicare beneficiaries in Florida and Connecticut. We focus on customer service, continuous improvement, and compliance. Our employees are committed to living by the values: The right things, the right way.

**NO RELOCATION BENEFITS WILL BE OFFERED WITH THIS POSITION**

JOB DUTIES

Job duties include, but are not limited to:

•Make medical review claims adjudication decisions.
•Review provider practices and identify issues of concern, overpayment and need for corrective action.
•Develop recommendations for further corrective action based on medical review findings.
•Implement corrective action related to medical review activities.

JOB REQUIREMENTS

*Licensed Registered Nurse
*1 to 3 Years Clinical Experience
*Strong written and oral communication skills
*Be able to research medical and health care delivery issues

Business Specific Criteria (preferred skills):

*Knowledge of Medicare Part B Redeterminations
*Multi-Carrier System Production (MCSPROD)
*Quality Management System (QMS) on-line manual
*Multi-Carrier System TACS system
*Client Automation System (CAS)