Top 8 Utilization review nurse Jobs in Montgomery Al

Medical Review Nurse- Medicaid
Peraton —Montgomery, AL
- $66,000 - $106,000 a year
- Remote
- Nursing
- RN License
- Bachelor of Science
- Health savings account
- Paid holidays
6d
Travel Case Management RN
Fastaff —United States
- Up to $2,826 a week
- Full-time
- Background check
- Nursing
- RN License
- Mileage reimbursement
- Health savings account
Quick Apply
9d
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
13d
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
Quick Apply

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utilization review nurse jobs near montgomery al

Medical Review Nurse- Medicaid

Peraton -
Montgomery, AL

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Job Details

$66,000 - $106,000 a year
6 days ago

Benefits

Health savings account
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Parental leave
Employee assistance program
Vision insurance
Life insurance

Qualifications

Nursing
Investigations regulatory compliance
Managed care
RN License
Regulatory compliance in claims processing
Health insurance knowledge
Nursing

Full Job Description

About Peraton

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees solve the most daunting challenges that our customers face. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

Program Overview

Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs.

About The Role

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are looking to add a Nurse Reviewer to our SGS team of talented professionals.

What you'll do:

The position requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. The incumbent will use a variety of tools to identify and develop cases for future administrative action, including referral to law enforcement, education, and overpayment recovery. Will work with external agencies to develop cases and corrective actions as well as respond to requests for data and support.

Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
Research regulations and cite violations.
Conduct self-directed research to uncover problems in Medicaid payments made to institutional and non-institutional providers.
Make claim payment decisions based on clinical knowledge
Telework available

Essential Functions:

This position may require the incumbent to appear in court to testify about work findings.
Ability to compose correspondence, reports, and referral summary letters.
Ability to communicate effectively, internally and externally.
Ability to handle confidential material.
Ability to report work activity on a timely basis.
Ability to work independently and as a member of a team to deliver high-quality work.
Ability to attend meetings, trainings, and conferences - overnight travel required

Qualifications

Basic Qualifications:

5 years with BS/BA; 3 years with MS/MA; 7 years with an Associates or 9 years with a HS degree
Experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity.
Current nursing license. Active license in the US
Strong investigative skills
Strong communication and organization skills
Ability to apply Federal, State and Managed Care Organization (MCO) regulations to claims under review
Strong PC knowledge and skills
Strong PC knowledge and skills
US. citizenship required

Desirable Qualifications:

Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases.
Have worked on cases involving services performed for Medicaid.
Have a CPC (Certified Professional Coder) certificate.

Details

Target Salary Range: $66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

Benefits Statement: Peraton offers eligible employees a variety of benefits including medical, dental, vision, life, health savings account, short/long term disability, EAP, parental leave, 401(k), paid time off (PTO) for vacation, and company paid holidays. A full listing of available benefits can be viewed at https://www.careers.peraton.com/benefits.

Application Statements: The application period for the job is estimated to be 30 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates. By applying to this job, you are expressing interest in the role and the Company. During the review of your application, you may be required to participate in an on-camera interview, as well as participate in a process to verify your identity.

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.

Apply Now

Refine Your Search

utilization review nurse jobs in montgomery al

Medical Review Nurse- Medicaid

Travel Case Management RN

Appeals Professional III (Licensed Clinician)

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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