Medical Review Nurse (RN)

ICONMA is a globally recognized, Woman-Owned staff augmentation and technology consulting firm. We specialize in connecting clients with top-tier professionals and providing digital solutions, empowering organizations of all sizes to achieve their business goals. By delivering exceptional workforce talent and tailored solutions we help businesses – from startups to Fortune 500 companies – drive innovation and growth. Since 2000, we have been a trusted partner. With our headquarters in Troy, Michigan, and over 15 global locations, we are ready to support your business wherever you are.

Our Client, a Mutual Insurance Holding company, is looking for a Medical Review Nurse (RN) for their Remote location.

Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and timeframes Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity Review cases and potential denials with the Medical Directors Research requests not clearly meeting established criteria Assist the Prior Authorization non-clinical reps with the Prior Authorization process Coordinate and maintain complete written documentation on all prior authorization’s requests. Collaborate with other Florida Blue departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors. Log into phone queue to service providers Answer inbound calls regarding authorizations within established time frame Document contact information in electronic medical record system Maintain productivity Handle calls professionally Provide accurate prior authorization information to provider offices