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Medical Review RN
The Judge Group Inc.

Bayonne, New Jersey

Posted in IT


This job has expired.

Job Info

Location: Bayonne, NJ
Salary: $33.00 USD Hourly - $34.00 USD Hourly
Description:
Judge Healthcare is seeking Registered Nurses for a Fully Remote Medical Review RN position for one of our biggest clients!

Job Title: Medical Review RN
Contract Duration: Approximately 6 months
Work Schedule: Monday to Friday, 8 hours per day (start time between 7 AM - 8 AM EST)
Preferred Locations: NJ, PA, NY, DE, or CT
Pay: $33-34/hr

Job Responsibilities:

  • Assess patients' clinical needs against established guidelines to ensure appropriate inpatient care and length of stay.
  • Evaluate the necessity, appropriateness, and efficiency of medical services and procedures.
  • Coordinate and assist in the implementation of care plans for members.
  • Monitor and coordinate services rendered outside the network and negotiate fees as appropriate.
  • Coordinate with patients, families, physicians, hospitals, and other external customers to ensure appropriate care from diagnosis to outcome.
  • Deliver high-quality, cost-effective care supported by clinical practice guidelines.
  • Monitor patients' medical care activities and outcomes for appropriateness and effectiveness.
  • Advocate for members and families to coordinate resource utilization and service evaluation.
  • Encourage member participation and compliance in case/disease management programs.
  • Document accurately and comprehensively based on standards of practice and organizational policies.
  • Communicate with multidisciplinary teams to ensure continuity and efficiency of care.
  • Understand fiscal accountability and its impact on resource utilization and self-care outcomes.
  • Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.
  • Complete other assigned functions as requested by management.


    • Requirements:
    • Active NJ or Compact RN license
    • Medical policy review and claims experience
    • Minimum of 3 years of RN experience in a clinical setting
    • Health insurance experience
    • Proficiency with Microsoft Office Suite

    Are you or someone you know interested? Reach out to Britney Bishop with an updated resume to bbishop@judge.com for immediate consideration!
    Contact: bbishop@judge.com

    This job and many more are available through The Judge Group. Find us on the web at www.judge.com


    This job has expired.

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