Christian Care Ministry · 1 month ago
Medical Review Nurse
Orlando, FL | Melbourne, FL | Hybrid
Full-time
Hybrid
Mid, Senior Level
$31.25/hr - $42.79/hr
5+ years expChristian Care Ministry is a healthcare sharing ministry for Christians that aims to connect people to a Christ-centered community wellness experience. The Medical Review Nurse will summarize and correlate medical reviews to determine eligibility of medical bills, spending a significant amount of time on pre-service and post-service reviews while collaborating with other departments to optimize cost savings.
Financial ServicesHealth CareNon Profit
Responsibilities
Organize and review medical records, lab results, radiology, and pathology reports for conditions ineligible for sharing (CIF’s)
Determine eligibility of members’ medical bills and/or upcoming procedures/treatments according to the program guidelines
Collaborate with other departments to maximize cost savings for individual cases and optimal outcomes for the members
Appropriately apply the program guidelines to the individual cases reviewed
Work autonomously to prioritize and manage workload
Document effectively in appropriate systems
Comply with all organizational HIPAA requirements
Contribute to the exercise and expression of the Ministry’s Christian beliefs
All other duties as assigned
Qualification
Required
Current Unrestricted LPN/LVN license with 5+ years' experience in a healthcare payer industry OR RN license with sound knowledge of anatomy and physiology and disease processes required
1-3 years' experience in medical reviews required
Understanding of medical bill processing and provider bill negotiation
Understand diversity of systems and work flows as they relate to the type of review or assignment
Able to multitask in multiple operating systems
Able to work for extended periods of time on the computer
Proficiency at interpreting medical records and writing detailed reports and conclusions
Strategic understanding of negotiations, third party processes, bill validation, and care management to determine when to utilize/defer to these processes for active review cases
Ability to be objective and impartial and conclude a case
Ability to communicate effectively with both internal and external customers
Practice good interpersonal skills and work as a member of a team
Possess the ability to adapt to changing processes
Working knowledge and application of program guidelines
Understanding of systems and work flows as they relate to the type of review or assignment
Ability to utilize the internet including e-mail and search engines
Word processing skills of at least 25 wpm
Basic knowledge in Microsoft Office (Excel, Word, Outlook) and ability to use a database system
Knowledge of document imaging system
Collaborates – builds partnerships and works collaboratively with others to meet objectives
Thoroughness – ensures information is complete, accurate; remediates errors when identified and applies feedback to avoid future mistakes
Innovation – able to develop and introduce new, improved methods for completing assignments
Managing Change – demonstrates support for departmental improvements with positive attitude
Forward Thinking – the ability to anticipate the implications and consequences of situations and take appropriate action to be prepared for possible contingencies
Preferred
2-3 years of clinical experience strongly preferred
Experience with Utilization Review or Case Management preferred
Benefits
100% paid Medical for employees/99% for family
Generous employer Health Savings Account (HSA) contributions
Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
6 weeks of paid parental leave (for both mom and dad)
Dental - two plans to choose from
Vision
Short-term Disability
Accident, Critical Illness, Hospital Indemnity
401(k) – up to 4% match on ROTH or Traditional contributions
Generous paid-time off and 11 paid holidays
Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
Employee Assistance Program including no cost, in-person mental health visits and employee discounts
Monetary Anniversary Awards Program
Monetary Birthday Awards
Company
Christian Care Ministry
Christian Care Ministry (CCM) is a non-profit that administers Medi-Share, a healthcare sharing program where Christians come together to share each other’s medical bills.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Ian Day
Chief Medical Officer
Recent News
Business Journals
2022-05-27
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