Professional Review Nurse Information

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CorVel Corp.

CorVel Corporation is a national provider of industry-leading workers’ compensation solutions for employers, third party administrators, insurance companies, and government agencies seeking to control costs and promote positive outcomes. We apply technology, intelligence, and a human touch to the challenges of risk management so our clients can intervene early and often while being connected to the critical intelligence they need to proactively manage risk. With a robust technology platform a... Read More

Address	801 Cherry Street, Fort Worth, TX 76102
Website	www.corvel.com/
Holding	No Holding Details

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Professional Review Nurse

     The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc.
Essential Job Duties:    Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager. Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans. Completely document work and final conclusions in designated computer program. Be responsive to additional Professional Review job duties as assigned by management or determined by legislative changes and/or market changes. Regularly attend internal educational/training conference calls.
Education/Training Requirements:    Must maintain current licensure as a Registered Nurse in the state of Tennessee with a minimum of 4 years clinical experience. A minimum of an Associates Degree in Nursing and a thorough knowledge of both CPT and ICD9 codes. Communicate concisely and effectively in writing and verbally. Ability to effectively interface with the claims adjusters, attorneys, physicians and their representatives, and advisors/clients, and co-workers. Effectively communicate with the Workers' Compensation Departments in Tennessee and Alabama both verbally and in writing. Must also have strong ability to negotiate provider fees. Previous experience in the following area is preferred: 1) Medical Bill Auditing 2) Clinical Experience in Operating Room, ICU, CCU, ER and/or Orthopedics 3) Knowledge of Workers' Compensation Claims 4) Prospective, concurrent and retrospective utlilization review
Application Instructions:    Please email resumes to Tennessee_Admin@CorVel.com

Other Job Information

Vacancy type:	Full Time	Contact Mode:	not provided
Fax:	949-851-1469	Contact Name:	not provided
Job Duration:	not provided	Phone:	949-851-1473
Email:	marketing@corvel.com