Remote Bill Review Nurse - Senior Case Manager

Summit Consulting; Gainesville (GA); Hybrid; USD 77,000 - 109,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Tuition reimbursement

Paid time off

Job summary

Summit Consulting seeks a skilled Registered Nurse with strong case management and managed care experience to review and optimize workers' compensation claims. The role involves auditing medical bills, advising on cost-control procedures, and supporting claims staff across a range of cases.

The position requires a Bachelor's degree in Healthcare Management or Nursing and an active RN license, with four days on-site and one remote day.

Qualifications

• Bachelor's degree in Healthcare Management or Nursing is required.
• RN license or current registration is required.
• Minimum years of case management or managed care experience is indicated.

Responsibilities

• Reviews Facility and Professional bills against medical records and diagnoses for appropriateness.
• Negotiates Pre-Surgical Services.
• Performs audits to identify leakage and process improvements.
• Provides expert advice to Claims staff on medical and cost-control procedures.
• Mentors staff and may participate in talent selection and performance reviews.
• May lead special projects and assist with other duties as assigned.

Skills

RN

Case management

Managed care

Data analysis

Education

Bachelor's degree in Healthcare Management or Nursing

RN license

Job description

Summit Consulting seeks a skilled Registered Nurse with strong case management and managed care experience to review and optimize workers' compensation claims. The role involves auditing medical bills, advising on cost-control procedures, and supporting claims staff across a range of cases.

The position requires a Bachelor's degree in Healthcare Management or Nursing and an active RN license, with four days on-site and one remote day.