MSA Nurse Reviewer

Santa Barbara Cottage Hospital; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading hospital is seeking Medical Analysts to prepare Medicare Set Asides and Cost Projections, requiring expertise in CMS policies and strong analytical skills. The role involves reviewing medical files, collaborating with a team, and providing medical recommendations. Candidates should have a Nursing degree and RN license, along with relevant experience in medical reviews.

Qualifications

• 3-5 years’ experience in Nursing preferred.
• Registered Nurse (RN) license in good standing required.
• Experience in preparing medical review reports preferred.

Responsibilities

• Provide a narrative and cost projection for future treatment.
• Collaborate with attorneys and medical professionals.
• Identify cost drivers and savings opportunities.

Skills

Analysis skills

Writing skills

Interpersonal skills

Education

Bachelor’s Degree, Associate Degree or Diploma in Nursing

Job description

Description

We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications. Candidates will demonstrate knowledge of CMS policies related to preparing MSAs. Strong writing skills, analysis skills and application of guidelines are required for this position. Medical Analysts will work closely with our attorneys and other members of the medical team to prepare Medicare Set-Asides and Medical Cost Projections.

Responsibilities

• Through a review of relevant medical files and related documentation, provides a narrative and cost projection for future treatment related to Worker's Compensation and Liability injuries consistent with the current guidelines
• Collaborates with a team of attorneys and medical professionals in identifying negotiating and documenting guidelines and cost reductions on future treatment plans
• Uses ISO Claims Partners proprietary information technology tools to identify diagnoses, treatment guidelines, and prescription medication pricing, and documents the case when applicable
• Provides additional analysis and medical recommendations as needed
• Identifies cost drivers and cost savings opportunities on all files and completes client specific -cost mitigation activities on files where applicable
• This is a full-time position, but additional hours may be required during peak time
• Occasional travel (<10% of the time)

Qualifications

About You and How You Can Excel in This Role

•Bachelor’s Degree, Associate Degree or Diploma in Nursing required
•3-5 years’ experience in Nursing preferred
•Registered Nurse (RN) license in good standing with applicable Board of Nursing required
•Experience in preparing medical review reports, medical bill reviews and utilization reviews in injury cases preferred
•Certification in any of the following preferred: Medicare Set-aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), Medical Coding, Legal Nurse Consulting, Rehabilitation Counseling, Disability Management, Utilization Review
•Strong interpersonal, oral, and written communication skills including report preparation preferred
•Ability to work effectively both independently and as a member of a team
•Ability to gather data, compile and synthesize information, including medical information, claims payment histories and billing, to identify level and types of services utilization

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