Medical Review Nurse - Remote

Overview

The Medical Review Nurse reviews, authorizes, coordinates, and responds to requests for services for Florida Blue members, utilizing clinical knowledge to make decisions based on established policies and procedures.

In Short

• Review and authorize phone/fax referral requests.
• Determine benefit coverage and medical necessity.
• Collaborate with Medical Directors on cases.
• Maintain documentation on prior authorizations.
• Answer inbound calls regarding authorizations.
• Provide accurate information to provider offices.
• Work on call for weekends and evenings.
• Document information in electronic medical records.
• Maintain productivity and handle calls professionally.
• Perform additional duties as assigned.

Requirements

• Active Florida State Registered Nurse (RN) license.
• Two years of clinical experience.
• Experience in Medicare or Managed Care.
• Knowledge of ICD-10, CPT-4, and HCPC coding systems.
• Excellent communication skills.
• Experience with multiple research/processing systems.
• Proficiency in MS Word, Excel, and PowerPoint.
• Ability to work on call as needed.

Benefits

• Comprehensive medical, dental, and vision insurance.
• Income protection benefits.
• Leave programs for personal circumstances.
• Retirement Savings Plan with employer contributions.
• Paid time off and volunteer time off.
• Wellness program and additional voluntary benefits.