Remote Marketing Intern (University Student)
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Support social media, branding and event campaigns at Berlin boutique agency PRIME AGENCY M&M while gaining practical experience alongside university studies.
Open
ExamWorks operates at the intersection of healthcare, consulting, and legal services, providing independent medical examinations and peer reviews for claims and related processes. Its work also includes bill reviews, Medicare compliance, medical-record and document management, and compliance auditing.
The company supports a broad physician network and develops enterprise platforms and workflow tools for healthcare organizations. Its teams combine clinical, operational, compliance, and technology expertise to help clients manage medical records and claims with greater consistency and reliability.
Utilization Review Nurse Auditor – New Jersey Remote
ExamWorks is seeking a remote Utilization Review Nurse Auditor in New Jersey to assess medical necessity, support regulatory compliance, and produce accurate utilization review determinations.
Description
- Conduct high-quality utilization reviews and approve appropriate, medically necessary care using evidence-based criteria
- Prepare peer review reports, correspondence, addenda, and supplemental review documentation
- Collaborate directly with providers to determine the appropriate level, intensity, and duration of care
- Record findings and assess medical necessity based on care frequency, intensity, and duration
- Complete reviews within applicable industry, client, federal, state, and URAC turnaround requirements
- Stay current with URAC and applicable state and federal regulatory requirements
- Keep utilization review records accurate and up to date in the designated database
- Guide Customer Service Representatives in delivering determination letters on schedule
- Support the resolution of client complaints and quality assurance matters
- Follow federal ERISA, URAC, and other applicable state requirements
- Inform management of compliance concerns related to products, company policies, procedures, and client specifications
- Attend company meetings, training sessions, and continuing education activities
- Handle other duties as assigned
Requirements
- High school diploma or equivalent is required
- Completion of an accredited nursing program
- An active, unrestricted Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license is required
- Three to five years of direct professional patient care experience
- Experience in utilization management is preferred
- Strong understanding of medical terminology, anatomy and physiology, treatment protocols, medications, and laboratory values
- Typing proficiency of at least 40 words per minute
- Ability to use computers, fax machines, copiers, scanners, and telephones
- Familiarity with multiple software applications, including Microsoft Suite
- Ability to accurately follow instructions and management direction
- Demonstrated accuracy, thoroughness, accountability for quality, initiative, and quality improvement skills
- Ability to work independently, prioritize tasks, and manage time effectively
- Ability to protect confidential information
- Ability to contribute to a positive, team-oriented work environment
- Ability to stay focused and perform effectively under pressure or stressful conditions
- Ability to respond appropriately to changes, delays, and unexpected events
- Ability to follow company policies and procedures
Benefits
- Medical, dental, and vision coverage
- Paid time off
- 401(k) plan
- Continuing education requirements
- Employer-provided training programs
- Fully remote work
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