Alabama Licensed RN Medical Reviewer

Job Summary

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

Key Responsibilities

• Conducts medical claim reviews and determines medical necessity based on clinical information and established guidelines
• Educates staff on medical reviews, terminology, coverage determinations, and coding procedures
• 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
• Valid, active, unrestricted RN licensure in the state of hire or compact multi-state RN licensure
• Two years of clinical nursing experience
• Working knowledge of word processing software
• Ability to work independently and prioritize effectively