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

For over 50 years, Verisk has been the leading data analytics and technology partner to the global insurance industry by delivering value to our clients through expertise and scale. We empower communities and businesses to make better decisions on risk, faster.

At Verisk, you'll have the chance to use your voice and build a rewarding career that's as unique as you are, with work flexibility and the support, coaching, and training you need to succeed. 

For the eighth consecutive year, Verisk is proudly recognized as a Great Place to Work® for outstanding workplace culture in the US, fourth consecutive year in the UK, Spain, and India, and second consecutive year in Poland.  We value learning, caring and results and make inclusivity and diversity a top priority.  In addition to our Great Place to Work® Certification, we’ve been recognized by The Wall Street Journal as one of the Best-Managed Companies and by Forbes as a World’s Best Employer and Best Employer for Women, testaments to the value we place on workplace culture.

We’re 7,000 people strong.  We relentlessly and ethically pursue innovation. And we are looking for people like you to help us translate big data into big ideas. Join us and create an exceptional experience for yourself and a better tomorrow for future generations.

Verisk Businesses

Underwriting Solutions — provides underwriting and rating solutions for auto and property, general liability, and excess and surplus to assess and price risk with speed and precision

Claims Solutions — supports end-to-end claims handling with analytic