JOB NUMBER: 1638 |
LOCATION: Remote
CLEARANCE/ACCESS LEVEL: NACI
This position is with our subsidiary, Avar Consulting Inc., an AMDEX Corporation Company
Registered Nurse (RN) ReviewerAvar Consulting, Inc, a wholly owned subsidiary of AMDEX Corporation, is a policy research firm with more than 20 years of leadership and experience in social science research, data collection and analysis, program evaluation, and policy analysis. Avar is recruiting a
Registered Nurse (RN) Reviewer to join our team.
Position Summary: The purpose of this position is to conduct audits on various discharge appeals, prepare cases for physician review, and perform related activities for selected cases on a timely, accurate, and efficient basis. This selected candidate will assist with documentation to meet CMS deadlines with special attention to traditional Medicare Fee for Service (FFS) and Medicare Advantage (MA) plan policies.
Primary Duties: Performs desktop non-physician review activities and audit functions. Abstract review related data/information accurately and timely utilizing appropriate review tools. Communicates with and supports physician reviewers in summarizing facts of cases and issues requiring physician input. Conducts all mandatory case review and quality assurance activities as stipulated by contract(s) and maintains required timeliness and accuracy within the review process while maintaining production goals. This position requires attention to detail, organization skills and ability to work in a fast-paced environment.
Required Qualifications / Experience: - Graduation from an accredited school of nursing and possess active professional licensure.
- Minimum of 2-4 years of experience in clinical decision making, relative to Medicare patients.
- Must have a dedicated home office and reliable internet access to allow for secure viewing of protected health information.
- General knowledge of a PC-based computer system.
- Intermediate knowledge of various MS Office programs with the ability to learn additional software applications as needed.
- Experience with Medicare Appeals processing / BFCC Medicare Quality Improvement Organization (QIO) core functions is desirable but not required.
Individuals with a degree in a healthcare-related field who possess professional clinical backgrounds with Medicare QIO experience in performing medical reviews in support of discharge appeals, claims reviews, and utilization reviews may also qualify (note, this is not a Physician Reviewer position!).
Part-time and full-time roles are available.
*Due to the nature of the contracts we support, only US citizens and permanent residents will be considered for this role.AMDEX Corporation offers a competitive salary package and attractive benefits package.- Medical | Dental | Vision (Base plan employee premiums 100% company paid)
- Employer Paid Life and Disability Insurance, STD and LTD
- Employee Assistance Plan and Employee Discounts
- 11 Federal Holidays | PTO accrual with carryover
- 401(k) Plan with company match | Flexible Spending Accounts: Medical, Dependent, Transit
- Tuition Reimbursement & Training Assistance
Visit our Careers website at www.amdexcorp.com/amdex-ai-jobs/ 
