NewWave HQ

Registered Nurses (RN)

Job ID 2018-1038

Overview

The Capitol Bridge/ NewWave Team provides an innovative perspective on the development and execution of human services program models. This perspective is built upon a comprehensive understanding of the intersection between policy and practice within all areas of human services programs. Our team is comprised of a diverse group of nationally recognized workforce development experts with decades of experience at all levels of government. Ranging from policy development through operations management, the Capitol Bridge/ NewWave Team serves as a trusted partner in meeting the goals and vision of Human Services Agencies.  

Responsibilities

  • Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare’s interests as pertaining to future medical service needs of beneficiaries
  • Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel
  • Render medical/clinical determinations based on professional experience
  • Implement operating rules and CMS policy
  • Answer phone requests for status or additional information on development letters

Qualifications

  • Bachelor’s degree from an accredited college or university in Nursing required
  • At least 3 years’ related experience required
  • Must be must be a US Citizen with the ability to obtain a Government Clearance
  • Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers’ compensation fee schedules in pricing medical items and services
  • Medicare Set-Aside Certified Consultant (MSCC) certification required (obtainable within 3 months of hire)
  • Medical/Utilization Review experience preferred
  • Medicare Set-Aside Arrangement experience required
  • Additional Knowledge of:
    • Healthcare Common Procedure Coding System (HCPCS) coding practices
    • Medicare coverage guidelines
    • Anatomy, physiology, and pharmacology
    • Clinical practice guidelines
    • Utilization review standards and practices
    • State-specific workers’ compensation guidelines and pricing structure
    • Health Insurance Portability and Accountability Act (HIPAA) and related healthcare confidentiality regulations

FLSA CLASSIFICATION:  Exempt

 

INTERPERSONAL SKILLS:

  • Excellent interpersonal, communication, and organizational skills.
  • Excellent written and verbal communication skills – must be able to communicate fluently in English both verbally and in writing
  • Should be extremely facts and data oriented.
  • Should be deadline and closure oriented.
  • Strong communication, interpersonal, persuasion, facilitation and influencing skills.
  • High Energy Levels. Should be self-driven.
  • Strong analytical, organizational and project management skills.
  • Demonstrated ability to lead and work with cross functional teams including senior level individuals.
  • Must be able to thrive in a fast-paced, rapidly evolving environment with varying priorities, based on a team building culture.

 

NWT is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.

 
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