- 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
- 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.