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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in New Jersey Auto PIP/No-Fault processes, medical necessity reviews, and clinical outcomes analysis. Proficient in educating patients and providers on pre-certification procedures while effectively managing support staff.
Highest-signal resume keywords
New Jersey Auto PIP/No-Fault KnowledgeInterQual KnowledgeCPT and ICD-9/ICD-10 CodingActive New Jersey State Nursing LicenseMed-Surg Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Pre-Certification ReviewsMedical ManagementClinical Outcomes AnalysisTyping Speed of 45–50 Words Per MinuteMicrosoft Office Suite Proficiency
Soft Skills
Interpersonal SkillsCommunication SkillsPresentation SkillsDetail-OrientedAbility to Multitask
Tools & Technologies
Review ManagerCERME
Certifications & Qualifications
Active New Jersey State Nursing LicenseGraduate of an Accredited School of Nursing
Industry Keywords
Auto ClaimsPre-Certification ProcessGoverning Laws
About the role
Key responsibilities & impact- Perform pre-certification reviews to determine the medical necessity of requested services for New Jersey Auto No-Fault injuries
- Work Monday to Friday in a full-time role
- Complete training at the Hamilton, New Jersey office
- Educate patients and the provider community about the pre-certification process and governing laws
- Provide instruction and direction to support staff
- Apply clinical outcomes, logic, and reasoning to identify appropriate alternative courses of care
Requirements
What you’ll need- New Jersey Auto PIP / No-Fault knowledge preferred
- Knowledge of InterQual, Review Manager, or CERME preferred
- Knowledge of CPT and ICD-9/ICD-10 diagnosis coding
- Knowledge of medical management related to auto claims preferred
- Proficiency with Microsoft Office Suite programs
- Knowledge of English language structure, composition, grammar, meaning, and spelling
- Strong interpersonal, communication, and presentation skills
- Ability to use logic and reasoning to identify appropriate alternative courses of care based on individual clinical outcomes
- Ability to work independently
- Ability to provide instruction and direction to support staff
- Ability to educate patients and the provider community regarding the Pre-Certification process and governing laws
- Detail-oriented and able to multitask
- Typing speed of 45–50 words per minute
- 3 years of Med-Surg experience required
- Active New Jersey State Nursing License in good standing — LPN/RN required
- Graduate of an accredited school of nursing