Medical Nurse Specialist (MBRU)

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Job Type:

Full time

 

Exempt/Non Exempt:

 

Salary

Job Description:

 

Medical Nurse Specialist (MBRU) - The Auto Club Group

What will you do:

The Auto Club Group is seeking prospective Medical Specialist who will review medical documentation on billing software to determine appropriateness of medical care as it relates to automobile accidents.

In this position, you will have the opportunity to:

• Identifies and coordinates customers' access to medical services, including alternative care options. 

• Interacts with physicians and other medical personnel to ensure appropriateness and medical necessity of treatment, length of stay and use of ancillary services. 

• Ensures treatment is reasonably necessary for an injured person's care, recovery or rehabilitation as defined by Michigan No Fault Act.

• Reviews and monitors the insured's medical records/bills for complete, timely and accurate entries. Consults with physicians of multiple specialties as well as other health professionals regarding bill dispute resolution. 

• Works closely with claim representatives and serves as a resource for claims staff by providing medical direction on claims. 

• Gathers and analyzes data and reports in order to identify discrepancies, trends or issues. 

• Provides technical assistance to clinical and administrative staff regarding the development of quality improvement indicators/monitors and measurement methodology. 

• Conducts special studies and prepares report on findings.

Work Environment

This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.

With our powerful brand and the mentoring, we offer, you will find your position as a Medical Specialist can lead to a rewarding career at our growing organization.

How will you benefit:

• A competitive annual salary between $75,000 to $80,000

• ACG offers excellent and comprehensive benefits packages, including:

• Medical, dental and vision benefits

• 401k Match

• Paid parental leave and adoption assistance

• Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays

• Paid volunteer day annually

• Tuition assistance program, professional certification reimbursement program and other professional development opportunities

• AAA Membership

• Discounts, perks, rewards, and much more

We’re looking for candidates who:

Required Qualifications (these are the minimum requirements to qualify):

Education (include minimum education and any licensing/certifications):

• Associate’s degree in nursing with licensure in State of Michigan as a Registered Nurse

• A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.

Experience:

• Quality assurance/utilization review

• Monitoring medical records to assess and evaluate utilization of services, quality of care, and identification of potential risk factors

• Conducting special studies/analyses and summarizing findings in report form

• Research statistics and quality improvement methodologies

Knowledge and Skills:

Knowledge of:

• Injury rehabilitation techniques

• Utilization review and quality assurance standards and programs through reading and attendance at seminars and involvement in professional organizations

• Personal computers, including word processing spreadsheet and database software packages

• CPT and ICD-9 coding

Ability to:

• Provide education and technical information to staff regarding utilization review and company standard medical protocols and changes

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