MSA Nurse Reviewer

Company Description

We help the world see new possibilities and inspire change for better tomorrows. Our analytic solutions bridge content, data, and analytics to help business, people, and society become stronger, more resilient, and sustainable.

Job 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.

About the Day to Day Responsibilities of the Role

•            Through a review of relevant medical files and related documentation, provides a narrative and cost projection for future treatment related to Workers 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

Additional Information

In 2022, Verisk received Great Place to Work® Certification for our outstanding workplace culture for the sixth year in a row and second-time certification in the UK, Spain, and India. We’re also one of the 38 companies on the UK’s Best Workplaces™ list and one of 18 companies on Spain’s Best Workplaces™ list.

For over fifty years and through innovation, interpretation, and professional insight, Verisk has replaced uncertainty with precision to unlock opportunities that deliver significant and demonstrable impact. From our historic roots in risk assessment, we’ve grown to provide analytic insights that help transform industries focused on some of the world’s most critical areas. Today, the insurance industry relies on Verisk to be, and to make the world, more productive, resilient, and sustainable.

Verisk works in collaboration with our customers and at the intersection of people, data, and advanced technologies. Through proprietary platformed analytics, advanced modeling, and interpretation, we deliver immediate and sustained value to our customers and through them, to the individuals and societies they serve, with greater speed, precision, and scale.

We’re 9,000 people strong, committed to translating big data into big ideas. We help others see new possibilities and empower certainty into big decisions that impact individuals and societies. And we relentlessly and ethically pursue innovation to help move our customers, and the world, toward better tomorrows.

Everyone at Verisk—from our chief executive officer to our newest employee—is guided by The Verisk Way, to Be Remarkable, Add Value, and Innovate.
• Be Remarkable by doing something better each day in service to our customers and each other
• Add Value