Job description
*This position is on the SUR team located Remote, Texas*
Position Purpose:
Conducts contract activities in accordance with state agencies and the state policies and requirements.
Essential Responsibilities:
- Obtains and reviews medical records to determine compliance with review and program policies.
- Documents review findings and recommends adjustments or denials of services for each claim detail.
- Obtains physician/dentist decisions on medical necessity-related findings.
- Composes narrative summary of record review findings and writes education or recoupment letters as directed.
Minimum Qualifications
Education
- Diploma Nurse or Associates degree in nursing or related discipline from an accredited college or university
License and Certification
- Registered Nurse (RN) with an active Texas license
- Coding Certification, preferred
Experience
- Three (3) years healthcare
- Two (2) years clinical in a healthcare setting
- One (1) year utilization management, retrospective review, medical record review, or claims review
Benefits
TMF offers an excellent benefits package, including:
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- Competitive salary
- License/credentials reimbursement
- Tuition Reimbursement
Please visit our Career Center to Apply and View the Full Job Description
https://jobs.tmf.org/
EOE Minorities/Females/Vet/Disability
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Tuition reimbursement
- Vision insurance
Work Location: Remote
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