Alabama Licensed RN Medical Reviewer
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Job Summary
Working remotely on a full-time basis, the Alabama Licensed RN Medical Reviewer will perform medical reviews of claims, determine medical necessity, and document decisions based on established criteria and clinical guidelines.
Key responsibilities
- Conduct medical claim reviews for complex services, preauthorization requests, and appeals
- Make payment determinations based on clinical information and document medical rationale for decisions
- Educate internal and external staff on medical reviews, terminology, and coding procedures
Required qualifications
- Associate's degree in a job-related field or graduate of an accredited School of Nursing
- Active RN licensure in the state of Alabama or an active compact multistate RN license
- Two years of clinical experience
- Proficiency in Microsoft Office and word processing software
- Ability to handle confidential information with discretion and demonstrate good judgment
Complete Job Description
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