Registered Nurse – MCP Specialist

Job Location: Nationwide
Posted: 08/04/2017

Job Title: Medical Cost Projection Specialist

FLSA Status: Exempt

Shift: 1st shift with flexibility to work extended hours based on operational needs

Travel: Less than 5%

Reports to: Director of Clinical Services

Department: MSA Production

Location: NuQuest – Nationwide

Summary:

Performs file reviews, prepares future medical cost projections and Medicare Set-aside Allocation reports. Interacts regularly with the Quality Management Team and Service Coordination Unit.

Essential Duties:

  • Performs file reviews
  • Conducts analysis of treatment patterns to identify and compile future medical costs
  • Researches Medicare coverage issues
  • Communicates frequently an effectively with Quality Management Team and Service Coordinators
  • Reviews resources on the Medical Cost Projection I-Portal frequently
  • Ensures thorough and accurate file documentation
  • Prepares future medical cost projections and Medicare Set-aside Allocation reports.
  • Performs other duties as assigned

Competencies:

  • Analysis – the individual demonstrates expert ability in analyzing claims, files and medical records and projecting the appropriate treatment protocol relative to the injury or illness.
  • Research and Cost Projection – the individual can skillfully research and compile medical costs associated with carrying out projected appropriate medical treatment over the lifespan of the claimant. The individual can skillfully research and interpret Medicare guidelines and MSP statutes.
  • Mathematics- the individual has mastery of basic mathematics and accurately adds, subtracts, multiplies, divides, calculates percentages, and fractions.
  • Written communications – the individual edits work for spelling, grammar, presents numerical data effectively and is able to interpret written information, medical terminology, and reports.
  • Interpersonal skills – the individual maintains confidentiality, remains open to other’s ideas and exhibits willingness to try new things.
  • Quality Control – the individual demonstrates accuracy and thoroughness and monitors own work to ensure quality.
  • Adaptability – the individual adapts to changes in the work environment, manages competing demands and is able to deal with frequent change, delays or unexpected events.
  • Decision making skills – the individual is able to make sound decisions, exercise expert judgment, and work independent of direct supervision.

Qualifications:

Required:

  • Current RN license and current credentials in at least one of the following CDMS, CLNC, CCMC,CRRN, QRP, LNCC, CIC, LHRM, CHCQM, LCP, CLCP
  • Must have MSCC or obtain MSCC within 90 days of employment
  • 3-5 years clinical nursing experience
  • 3-5 years of experience with Workers’ Compensation or Liability cases
  • Proficiency with MS Office Suite
  • Accurate typing skills and proficiency
  • Excellent telephone demeanor
  • Ability to work additional hours or a flexible schedule based on occasional increased work demands

Environmental Conditions:

  • This position works from the employee’s home. Work is primarily done indoors, in an office environment with a low to moderate noise level.

Physical requirements necessary on a regular basis:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

  • Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse, and telephone 7-8 hours per day
  • Speech and hearing sufficient for in-person and telephone communication 7-8 hours per day
  • Vision sufficient for use of a computer monitor
  • Ability to sit at a desk 7-8 hours per day

This job description is not meant to be an all-inclusive statement of the duties of the position listed above. Other appropriate duties may be required from time to time.

When duties and responsibilities change and develop, the job description will be reviewed and is subject to changes due to business necessity.

NuQuest, a subsidiary of Brown and Brown, Inc., is an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.

Interested candidates may submit resumes to NQRecruiting@mynuquest.com

About NuQuest

NuQuest, a subsidiary of Brown and Brown, Inc., is an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.

Interested candidates may submit resumes to nqrecruiting@mynuquest.com