Arizona Licensed Medical Claim Nurse

Job Summary

A company is looking for an RN Medical Claim Review Nurse Remote.

Key Responsibilities

• Perform clinical/medical reviews of medical claims and previously denied cases to ensure medical necessity and accurate billing
• Validate member medical records and claims to ensure appropriate reimbursement to providers
• Assist with complex claim reviews and provide clinical resource support for utilization management and member/provider inquiries

Required Qualifications

• At least 2 years of clinical nursing experience, preferably in a hospital setting, with experience in utilization review or medical claims review
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Experience with applicable state, federal, and third-party regulations
• Strong organizational and time-management skills
• Proficiency in Microsoft Office and ability to learn new software programs