Travel Nurse RN - $1,539 per week in Newark, NJ
Company: Infojini Healthcare
Location: Newark
Posted on: June 30, 2025
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Job Description:
ID: 54316582 Shift: Unknown Description: Job Summary: This
position is responsible for the medical policy determination of
claims/cases consistent with Plan Medical Policy to ensure
appropriate and efficient utilization of benefits. Additionally,
the position is responsible for the research and analysis of
medical techniques, procedures and products and for recommendations
in the formulation of draft medical policy. Responsibilities:
Provide timely and accurate responses to inquiries from the claim
policy teams in relation to courtesy pre-d requests, claims pending
for medical review and appeal inquiries. Prepares cases for Medical
Director Review and or outside consultant review and response where
appropriate. Responsible for processing pends for which the Medical
Policy Inquiry Resolution team has authority to do so. Identifies
opportunities for development of or revisions to Horizon Medical
Policy based on case review. Responsible for identifying areas and
pursuing solutions where medical policy is not being applied
correctly in claim payment outcome. Responsible for managing
inventory assigned, documenting production in RMRS and follow
through on all assigned inquiries. Responsible for staying abreast
of all mandates, policy changes, workflow changes impacting
outcomes. Performs special projects as assigned by management.
Demonstrates knowledge and understanding of the laws regulations
and policies that pertain to the organization unit's business and
conforms to these laws, regulations and policies in carrying out
the accountabilities of the job.Qualifications:
Education/Experience 1. Requires an associate or bachelor's degree
(or higher) in nursing and/or a health-related field OR accredited
diploma nursing school. 2. Requires a minimum of two (2) years
clinical experience. 3. Requires minimum of three (3) years'
experience in the health care delivery system/industry. Additional
licensing, certifications, registrations Active Unrestricted RN
License Required; NJ License Preferred Prefer Certified
Professional Coder credentials.Knowledge - Must be proficient in
the use of personal computers and supporting software in a Windows
based environment, including MS Office products (Word, Excel,
PowerPoint) and Lotus Notes; Should be knowledgeable in the use of
intranet and internet applications. Skills and Abilities - Must
have effective verbal and written communication skills and
demonstrate the ability to work well within a team. Demonstrated
ability to deliver highly technical information to less technical
individuals. Must demonstrate professional and ethical business
practices, adherence to company standards, and a commitment to
personal and professional development. Proven time management
skills are necessary. Must demonstrate the ability to manage
multiple priorities [or tasks], deliver timely and accurate work
products with a customer service focus, and respond with a sense of
urgency as required. Demonstrated ability to work in a production
focused environment. Proven ability to exercise sound judgment and
strong problem-solving skills. Proven ability to ask probing
questions and obtain thorough and relevant information. Must be
client service focused with effective ability to empathize. Detail
Labor Detail Position - US Guaranteed Hours: Contract
Keywords: Infojini Healthcare, Jersey City , Travel Nurse RN - $1,539 per week in Newark, NJ, Administration, Clerical , Newark, New Jersey
