Medical Review Supervisor

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* ** Preferred candidate will live within 40 miles of Nashville, TN*
* ** or Columbia, SC.
** If living in Nashville or Columbia, this will be an onsite position. Hybrid schedule may be considered.
* Superior candidates with preferred experience and skills will also be considered. These candidates will work from home, if selected.  To work from home, you must have high-speed internet (non-satellite) and a private home office.
* Work hours are 8:00 am to 4:30 pm CT. Monday through Friday.
* ** Required Licenses and Certificates**:
Active, unrestricted RN licensure from the United States and in the state of hire,
** OR
* * active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact NLC), OR, active, unrestricted licensure/certification from the United States and in the state of hire in specialty area as required by hiring division/area, OR for Div. 75 only, active, unrestricted licensure as social worker, counselor, or psychologist from the United States and in the state of hire.

For Divs. 55 and 75 only:
Supervisors of Case Management must obtain CM certification within 3 years of hire.
* ** Required

Skills and Abilities:

** Working knowledge of word processing, spreadsheet, and database software. Ability to work independently, prioritize effectively, and make sound decisions. Working knowledge of managed care and/or various forms of health care delivery systems; strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. Knowledge of specific criteria/protocol sets and the use of the same. Good judgment skills. Demonstrated customer service, organizational, and presentation skills.

Demonstrated proficiency in spelling, punctuation, and grammar skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to lead, motivate, and assess performance of others.
* ** Required Software and Tools:
** Microsoft Office.
** Required

Education:

** Associates in a job-related field
** OR
* * graduate of Accredited School of Nursing. Degree Equivalency:
Graduate of Accredited School of Nursing
** Required

Work Experience:

** Five years clinical
** OR
* * five years utilization review/medical review experience (Three of the five must be clinical). One year team lead/leadership role or equivalent military experience in grade E4 or above (may be concurrent with the five years).
* Solid experience with and knowledge of Medicare Regulations.
* Five years clinical experience as a Registered Nurse in the following specialty area(s):
Outpatient Surgical, Pain Management, Cosmetic Surgery, Prior Authorization, Medical Review, Medicare Part A or Utilization Management.
* Experience with HOPD (Hospital Outpatient Department) and Prior Authorization of RSNAT (Repetitive, Scheduled Non-Emergent Ambulance Transport).
* Ability to work with multiple windows-based programs simultaneously.
* Developing and using validation reports.
* Intermediate Word, Excel and Outlook skills.
* Subsidized health plans, dental and vision coverage
* 401k retirement savings plan with company match
* Life Insurance
· Paid Time Off (PTO)
* On-site cafeterias and fitness centers in major locations
* Education Assistance
* Service Recognition
* National discounts to movies, theaters, zoos, theme parks and more.
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