Alabama Licensed RN Medical Reviewer

Job Summary

Providing expert medical reviews in a fast-paced remote environment, the full-time Alabama Licensed RN Medical Reviewer will evaluate medical claims, document decisions based on established guidelines, and collaborate with cross-functional teams to support medical review processes.

Key responsibilities

• Perform medical claim reviews for complex services, preauthorization requests, appeals, and coding accuracy
• Educate internal and external staff on medical reviews, terminology, and coverage determinations
• Participate in quality control activities and provide guidance to team members while assisting with special projects

Required qualifications

• Associate's degree in a job-related field or graduate of an accredited School of Nursing
• Active, unrestricted RN licensure in Alabama or a compact multistate unrestricted RN license
• Minimum of 2 years clinical experience plus 1 year in utilization/medical review or quality assurance
• Proficiency in Microsoft Office and ability to navigate spreadsheets
• Strong analytical skills and ability to handle confidential information with discretion