Medical Nurse Specialist; MBRU

It's a great time to join AAA The Auto Club Group!

JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD

Job Type: Full time

Exempt/Non Exempt:

Salary

The Auto Club Group is seeking a prospective Medical Specialist who will review medical documentation on billing software to determine appropriateness of medical care as it relates to automobile accidents.

In this position, you will have the opportunity to:

• Identify and coordinate customers' access to medical services, including alternative care options.
• Interact with physicians and other medical personnel to ensure appropriateness and medical necessity of treatment, length of stay and use of ancillary services.
• Ensure treatment is reasonably necessary for an injured person's care, recovery or rehabilitation as defined by Michigan No Fault Act.
• Review and monitor the insured's medical records/bills for complete, timely and accurate entries. Consult with physicians of multiple specialties as well as other health professionals regarding bill dispute resolution.
• Work closely with claim representatives and serve as a resource for claims staff by providing medical direction on claims.
• Gather and analyze data and reports in order to identify discrepancies, trends or issues.
• Provide technical assistance to clinical and administrative staff regarding the development of quality improvement indicators/monitors and measurement methodology.
• Conduct special studies and prepare report on findings.

This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.

With our powerful brand and mentoring, you will find your position as a Medical Specialist can lead to a rewarding career at our growing organization.

• A competitive annual salary between $75,000 to $80,000
• ACG offers excellent and comprehensive benefits packages, including:
• Medical, dental and vision benefits
• 401(k) Match
• Paid parental leave and adoption assistance
• Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
• Paid volunteer day annually
• Tuition assistance program, professional certification reimbursement program and other professional development opportunities
• AAA Membership
• Discounts, perks, rewards, and much more

• Associate's degree in nursing with licensure in State of Michigan as a Registered Nurse
• A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.

• Quality assurance/utilization review
• Monitoring medical records to assess and evaluate utilization of services, quality of care, and identification of potential risk factors
• Conducting special studies/analyses and summarizing findings in report form
• Research statistics and quality improvement methodologies

Knowledge of:

• Injury rehabilitation techniques
• Utilization review and quality assurance standards and programs through reading and attendance at seminars and involvement in professional organizations
• Personal computers, including word processing spreadsheet and database software packages
• CPT and ICD-9 coding

• Provide education and technical information to staff regarding utilization review and company standard medical protocols and changes
• Work effectively with customers
• Communicate effectively with others in a work environment, other professionals and health care providers, and with the public
• Gather and analyze data and reports, identify discrepancies, problems or issues and recommend action plans based on findings
• Analyze complex reports and information related to and resulting from quality reviews
• Utilize computer systems
• Work with a team on individual claims to ensure appropriateness of treatment
• Strong written and oral communication skills.

• Bachelor's degree in nursing
• Reside in the State of Michigan

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.

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