Nurse Medical Allocator
Location: Mandeville Louisiana
Description: York Risk Services Group Inc. is employing Nurse Medical Allocator right now, this career will be placed in Louisiana. Detailed specification about this career opportunity please give attention to these descriptions. This position supports the Claims Team and/or other clients by providing consultations, file reviews, development of summaries related to the medical component of the file, prov! iding recommendations for medical reserves throughout the life of the Workers’ Compensation or Liability claim, or completing a Medical Cost Projection or Medicare Set Aside Arrangement (MSA). The nurse in this position has a complete working knowledge of the Medicare Secondary Payer Act and the rules and regulations related to the same.
Provides medical consultation, direction (including file reviews, participation in discussions related to the medical component of the file or Medicare Secondary Payer Act compliance).
Be able to determine which product (MSA or MCP) is appropriate in a particular situation.
Be aware and work within current Medicare guidelines with regard to MSA requirements and MSA submissions.
Perform conditional payment review and resolution as requires on a timely basis.
Review claim files and make recommendations prior to the request for an MCP or MSA. For example- give advice regarding pharmacy review or M! CM assignment.
Review medical reports and make determ! ination on which should be used to obtain the best rated age.
Communicates with the field nurse case managers, claim staff, as needed, to assist in the medical component of the file.
Review claim files and medical records in order to produce MCP and MSA reports within a specified timeframe.
Establishes medical reserves and/or medical allocations as needed for both the internal and external client.
Generates formal written reports and documents meeting requirements for internal processes (Medical Reserve Setting) and external processes (MSA and Medical Cost Projection).
Coordinates or completes the MSA Submission process in compliance with the CMS standards.
Maintains claimant confidentiality.
Other duties as assigned.
Required Skills
Computer Skills
Proficient in Microsoft Office Products and able to work in multiple electronic systems
Certificates & Licenses
Current ! RN or LPN with current valid state license required; Medicare Set Aside Consultant Certified preferred. Certified Case Manager preferred
Required Experience
Education : Licensed Practical Nurse, Associate Degree or Bachelor's Degree required. BS or BSN preferred.
Experience: Minimum of three years clinical nursing experience. Case Management experience preferred. Medicare Set- Aside allocation experience preferred.
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to York Risk Services Group Inc..
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Wed, 08 May 2013 08:01:09 GMT
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