Job Listing: Registered Nurse - Case Reviewer

Our client in Rockville, MD is looking for a Registered Nurse Case Reviewer.

-Responsible for providing a comprehensive resource for patients, physicians, other health care providers, and manufacturer sales representatives for complex therapy.
-This includes but is not limited to conducting in-depth reimbursement activities, processing general product and support service inquiries, drafting and submitting appeals for denials.
-Position is significant in clearing financial obstacles for patients to receive complex therapies. Requires knowledge of health insurance, reimbursement and financial expectations surrounding health care.
-Manage nationwide caseloads with various insurance carriers, Medicaids and Medicare.
-Identify clinical requirements prior to initiation & for duration of services. Identify potential financial risks; recognize trends.
-Define appeal/claim submission procedures and appeal considerations.
-Must have excellent communication and problem solving skills.
-Also requires excellent attention to detail and the ability to work in a fast paced environment where the solving of issues and management of exceptions to the rule is critical in meeting a variety of expectations.
-Must make independent decisions and require minimal supervision.
-Nurse provides review of submitted cases for prospective review of approval of therapy in accordance with health plan approved guidelines.
-Collaborates with customer service, admissions, pharmacy operations departments as well as health plans and their staff to implement Advanced Guideline Management Specialty Pharmacy Programs
-Upon receipt of referral, this position collects appropriate clinical/ medical data, performs clinical assessments using agreed upon criteria and coordinates communication of case review outcomes to health plan/employer group, physicians, patients and other health care professionals
-This position is responsible for implementing managing and participating in client reviews of program operations and results

Requirements:
-Registered nurse, with current valid nursing license.
-Minimum of 2+ years recent clinical experience with 2+ years of home infusion experience.
-Ability to become licensed in all 50 states.

Required Skills for Registered Nurse - Case Reviewer Job:

About Aerotek Scientific:

Join Aerotek Scientific LLCSM, one of the fastest growing providers of scientific and clinical research services in the nation. Due to our growth, we're constantly on the lookout for qualified professionals to place in contract, contract-to-hire, and permanent placement positions across the scientific and clinical research communities. At Aerotek Scientific, we know it's more than just your day-to-day responsibilities that can make or break a job. It's the support you get. That's the reason Aerotek Scientific offers a variety of benefits including medical, dental, optical, 401k, and many more. Don't put your career in the hands of just anyone, put it in the hands of a specialist. Join the Aerotek Scientific team! Allegis Group and its subsidiaries are equal opportunity employers.