Alabama Licensed Medical Reviewer

Job Summary

A company is looking for a Medical Reviewer II to perform medical reviews and support medical claims.

Key Responsibilities

• Conducts medical claim reviews and determines medical necessity based on established criteria and guidelines
• Educates staff on medical reviews, terminology, and coverage determinations
• Participates in quality control activities and provides guidance to team members

Required Qualifications

• Associate Degree in Nursing or Graduate of an Accredited School of Nursing
• Active, unrestricted RN license from the United States or a compact multistate RN license
• Two years of clinical experience as an RN
• Proficiency in Microsoft Office