Nurse Manager (BSN) 39190 - (US-IL-Any City )

Minimum Education: Tech School
Job Type: Full Time
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TrustSolutions
is a wholly owned subsidiary of Government Health Services, LLC, and is part of the WellPoint family of companies. TrustSolutions holds a Medicare Program Safeguard contract with the Centers for Medicare & Medicaid Services to help reduce fraud and abuse in the Medicare Program. Headquartered in Milwaukee, Wisconsin, TrustSolutions also has offices in California, Illinois, Michigan, Virginia, Indiana, Florida and Texas.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Nurse Manager (BSN)
This position is contingent upon contract award, and can be filled in any of these locations: MN, WI, IL, IN, MI, OH, or KY.


The MR (Medical Review) Manager is responsible for the oversight and performance of all medical review tasks within the task order. Under the direction of the MR Manager, the Medical Review team conducts pre-pay and/or post-pay medical claim reviews in support of Benefit Integrity functions. The MR Manager ensures that medical determinations and coverage decisions are appropriate and that MR team makes payment recommendations in accordance with stated/published practices, policies, or procedures. The MR Manager coordinates medical review efforts to coincide with the needs of the BI unit and provides medical knowledge and professional expertise to the team. Develops and implements the medical review strategy and ensures that data analysis is used effectively in identifying medical review targets that focus on MR for BI on areas of potential fraud and abuse. This position is responsible for the coordination of medical review activities with the benefit integrity management and other entities.

Skills:
BSN required, Nursing Diploma is not acceptableMust have a current, unrestricted RN licenseA minimum of three (3) years supervisory experience in the general area of medical/utilization review and Medicare.Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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