Medical Review Analyst - Registered Nurse

November 5

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Integrity Management Services, Inc.

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government contracting • statistical analysis • data mining • regulatory analysis • Woman Owned Small Business

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Description

• Integrity Management Services, Inc. (IntegrityM) specializes in assisting government healthcare organizations prevent and detect fraud and abuse. • We offer a culture of opportunity, recognition, and collaboration. • We are seeking a Medical Review Analyst (RN) with medical review experience. • The position requires conducting medical record reviews and applying clinical judgment to claim payment decisions. • Additional responsibilities may include research on medical claims data and utilize tools to detect potential fraud. • Conduct reviews under the guidance of a Medical Review Manager.

Requirements

• Strong investigative skills • Demonstrated proficiency in Medical Review work • Working knowledge of Medicare and Medicaid • Excellent communication skills • Demonstrated prioritization, problem solving, and organization skills • Strong computer skills including Microsoft Office proficiency • Preference: • Bachelors in of Science in Nursing (BSN) • 2+ years’ clinical experience • Required: • Current/active RN license • 5-7 years of experience in the medical field as a Registered Nurse or other clinician • Experience in review of medical claims for coverage and medical necessity • Enthusiastic individuals who can work effectively in a dynamic environment both in a team as well as independently is a must! • All candidates MUST pass a background check and drug screening prior to employment.