Medical Review NurseChristian Care Ministry (Medi-Share)

The range for this role is $73,000 - $99,500

Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. This role includes opportunity to receive an annual bonus target of 5% of annual eligible earnings. Actual bonus amounts are determined by length of time in role, individual performance, and organizational performance.

Interested applicants must be willing and able to work onsite minimum 4 times per week in either our Melbourne, FL or Orlando, FL office.

The Mission

At Christian Care Ministry we believe that Christians can, and should, share in one another's burdens. Through the use of Medi-Share®, a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.

The Team

Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren't perfect people, we are serving our perfect God and our Members to the best of our ability.

The Job

The Medical Review Nurse (Senior Clinical Reviewer) works to summarize and correlate concise, accurate information on medical reviews to determine eligibility of medical bills per the program guidelines. In this role, 70% of the time is spent performing pre-service and post-service medical reviews and/or reviews for high dollar, complex medical cases and collaborating with other departments to optimize cost savings. This position will be expected to make independent decisions regarding timing and omission of medical reviews in deference to other department processes based on the dollar amount of the bill and the Ministry's cost strategy.

Essential Job Duties & Responsibilities

• Organize and review medical records, lab results, radiology, and pathology reports for conditions ineligible for sharing (CIF's)

• Determine eligibility of members' medical bills and/or upcoming procedures/treatments according to the program guidelines 

• Collaborate with other departments to maximize cost savings for individual cases and optimal outcomes for the members

• Appropriately apply the program guidelines to the individual cases reviewed 

• Work autonomously to prioritize and manage workload

• Document effectively in appropriate systems

• Comply with all organizational HIPAA requirements

• Contribute to the exercise and expression of the Ministry's Christian beliefs

• All other duties as assigned

Education and/or Experience

• RN license with sound knowledge of anatomy and physiology and disease processes required

• 1-3 years' experience in medical reviews required

• 2-3 years of clinical experience strongly preferred

• Experience with Utilization Review or Case Management preferred

Supervisory Responsibilities

• This job has no supervisory responsibilities