Registered Nurse

<b>At LogistiCare, you have the ability to define your own career journey and enjoy the ride along the way and make possibilities real. Your growth is our objective. Whatever your passion, you’ll have the opportunity to find the career you’re looking for, learn and grow in your role, and make a difference in the lives of others. And you’ll do it alongside colleagues you can count on, in a vibrant work environment, with leadership that puts you first. <br/><br/>Sound like a good career fit? </b>

Edison, NJ


<strong><a href="" target="_blank" rel="noopener noreferrer">Who We Are: Transportation &amp; Integrated Health Services</a><br /></strong>Nation&rsquo;s largest manager of non-emergency medical transportation, provides 69+ million rides annually in 39 states and D.C. Supports integrated health care programs, improving care coordination for members and their corresponding providers and hospital networks.<br /><br /><strong>What We Value Most &ndash; YOU<br /><br />Benefits - The Whole Package&nbsp;</strong><br />Medical, Vision, Dental, Disability, EAP, Legal, Voluntary Life Insurance, Group Life &amp; AD&amp;D, Flexible Spend Account, Paid STD &amp; LTD, Vacation &amp; Holidays<br /><br /><strong>Culture - Why You Want to Come to Work Every Day</strong><br />Casual Dress - Business Casual, Relaxing - Comfy Lounge Areas, Excitement -Themed&nbsp; Luncheons, Great Hours &amp; Set Shifts - (Mon. &ndash; Fri.)<br /><br /><strong>View Featured Positions Below OR Check Out <a href=";d=ExternalCareerSite" target="_blank" rel="noopener noreferrer">All&nbsp;Career Journey Opportunities&nbsp;with LogistCare</a></strong>

keywords: nurse,analysis,operations,analysis,management,compliance,knowledge,license,skills,experience


Overview: The Registered Nurse will be responsible for reviewing non-emergency medical transportation claims for stretcher, ambulance and wheelchair transport. The Registered Nurse will review claims as requested by the Billing Operations to assist in determining the appropriate level of service based on clinical needs, medical necessity and medical appropriateness using CMS and HealthPlan criteria. The RN will have the authority to deny payment or downgrade payment levels based on their review. The RN may be required to attend tele-conferences with various HealthPlans or Medical Groups.
Responsibilities: <p><strong>Essential Functions and Responsibilities:</strong></p> <ul> <li>Review ambulance and stretcher transport claims for medical necessity and appropriateness to the level of service billed.</li> <li>Issue denial of payment or payment at a lower level on behalf of capitated plans when claim does not meet medical necessity or appropriateness for service performed.</li> <li>Serve as a liaison with Medical Directors/Case Managers at Medical Groups and/or HealthPlans related to ordering of non-emergency medical transportation.</li> <li>Maintain client confidentiality by compliance to HIPPA guidelines and LogistiCare confidentiality policy.</li> <li>Act as a resource for LogistiCare staff for all medical questions.</li> <li>Review payment appeals and grievances related to claims denied or downgraded.</li> </ul> <p><strong>Other Duties and Responsibilities:</strong></p> <ul> <li>Make suggestions for and updates policies and procedures as needed.</li> <li>Maintains all confidential client information in files.</li> <li>Destroys confidential information when appropriate by shredding.</li> <li>Participates in in-services as needed or requested by manager.</li> </ul>
Requirements: <ul> <li>Registered Nurse (RN) with 1+ years clinical experience.</li> <li>Managed care experience preferred within a healthplan or medical group setting.</li> <li>Exceptional interpersonal skills with excellent written and verbal skills.</li> <li>Knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services.</li> <li>Broad knowledge of health care system including hospital, nursing home and community medical knowledge.</li> <li>Knowledge/experience with ambulance or medical transportation preferred.</li> <li>Unrestricted State Medical License.</li> <li>Demonstrated leadership and management skills.</li> <li>Computer proficiency with Microsoft Office, Excel, and Access.</li> </ul>