Medical Review Nurse

3 weeks ago

Vermont, United States Genworth Financial Full time
  • About the Role:
    • This position is an excellent opportunity for a Registered Nurse to join the Genworth Financial team as a Medical Review Nurse.
    • The successful candidate will be responsible for improving our in-house certification functions by providing updates to the plan of care, in-house certifications, completing assessments, and monitoring low-risk claimants.
    • The role will promote the provision of evidence-based, short-term case management services to long-term care insurance policyholders.
    • Responsibilities:
      • Communicate with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax-qualified certifications as required by the policy.
      • Obtain information about the medical status and care needs of the insured to best understand the disease progression, ADL/IADL loss, and cognitive status.
      • Make decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification.
      • Work within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices.
      • Communicate, team, and collaborate, and partner with other teams or departments to achieve common goals and support continuous improvement initiatives.
      • Identify, request, and analyze pertinent medical records required to best understand the disease progression, ADL/IADL loss, and potential for recovery.
    • Requirements:
      • Active Registered Nurse (RN) licensure.
      • At least two years of experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical/cognitive function, as well as their prognosis and rehabilitative potential.
      • Ability to understand and interpret MDS, Plan of Care, Physician Records, and Occupational/Physical Therapist records and understand disease progression and recovery expectations.
      • Extraordinary internal and external customer service skills, including patience, tactfulness, ability to remain calm and composed under pressure, effective listening skills, and professionalism.
      • Ability to manage and prioritize a work queue and multiple job responsibilities.
      • Consistent, reliable, and predictable attendance to support the business needs.
    • Benefits:
      • Competitive compensation and total rewards incentives.
      • Comprehensive healthcare coverage.
      • Multiple 401(k) savings plan options.
      • Auto enrollment in employer-directed retirement account feature (100% employer-funded).
      • Generous paid time off, including 12 paid holidays, volunteer time off, and paid family leave.
      • Disability, life, and long-term care insurance.
      • Tuition reimbursement, student loan repayment, and training and certification support.
      • Wellness support, including gym membership reimbursement and employee assistance program resources (work/life support, financial & legal management).
      • Caregiver and mental health support services.
    • Additional Information:
      • The base salary pay range for this role starts at a minimum rate of $67,000 up to the maximum of $124,600.
      • In addition to your base salary, you will also be eligible to participate in an incentive plan.

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