Job Description SummaryJob Description Summary
The position requires a versatile, competent, experienced Nurse to serve as a Per Diem to perform a full range of professional office handling duties in a variety of departments.
Job DutiesJob Description
Major Duties and Responsibilities:
Daily assignment will be made based on production / staffing need, assignment will include but not be limited to;
- Perform utilization review per regulatory and client directed criteria
- Determine if requested (Prospective) or completed services (Retrospective) require physician review for level of care issues, causality or medical necessity
- Quality Assurance of Physician Letter Reports
- Determine if CPT codes reviewed are supported by documentation provided and eligible for reimbursement per guidelines
- Completion of Desk and/or Onsite Audits of facility / provider billing submission
- File review summaries
- Independent Medical Examination/Peer Review/Physician Advisor referrals
- Telephonic support for Adjusters, Internal/External Counsel, and other operational personnel
- Other duties as assigned
Job Related Skills/Experience:
- Registered Nurse (RN)
- Must possess an active, unencumbered license in state of residence and the State of New Jersey.
- Required to become CHCQM certified by the ABQAURP within one year of hire.
- 2-3 years previous case management/ UR experience with strong clinical back ground
- Minimum 1-year prior case management experience dealing with Auto PIP, Worker's Compensation, managed care, home care or rehabilitation preferred
- Knowledge of CPT, ICD and NDC codes, NCCI Edits, AMA and AAOS guidelines
- Multi State Knowledge of Regulations a plus
- Ability to handle multiple tasks
- Ability to work under moderate supervision
- Strong problem solving, critical thinking and interpersonal skills
- Excellent written and verbal communication skills
- Knowledge of computers, Excel, Word and Windows
This position is a Field (Remote-work from home) opportunity. Requires broadband internet access such as cable or Verizon FIOS - DSL and Satellite are not acceptable.
Why Choose CCC:
We promote a healthy work-life balance and offer generous benefit plans and resources designed with employee satisfaction in mind.
What we value is simple - customers, employee commitment, collaboration and clear communication.
We hire people who will embrace the company's goals and productively contribute in ways that help us serve the customer, innovate, and stay strong.
We make it a priority to keep employees healthy, happy and enriched.
Healthy - Wellness programs, competitive medical benefit offerings
Happy - Recognition programs, a confidential employee assistance program, Perkspot/employee discount program and potentially flexible work arrangements such as staggered start times
Enriched - Tuition reimbursement, training and learning programs, and leadership development opportunities
Our corporate headquarters is located in downtown Chicago within the historic Merchandise Mart-a certified LEED (Leadership in Energy and Environmental Design) building.
Please Note: Contingent Workers, Field Inventory Representatives and Interns are not eligible for the benefits above.
CCC Information Services was recognized by Forbes as one of America's Best Mid-Sized Employers in 2018 and ranked #17 in the Top 100 Digital Companies in Chicago in 2017 by Built In Chicago.
CCC is ready to help you shift your career into high gear. Let's get started!
Electronic Medical Record
Arm Hand Steadiness
Conducting Physical Examinations