Arizona Licensed Medical Review Nurse

Job Summary

A company is looking for a Medical Review Nurse (RN) specializing in itemized bill review.

Key Responsibilities

• Facilitates clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing
• Validates medical records and claims, ensuring appropriate reimbursement and identifying quality of care issues
• Serves as a clinical resource, providing training and support to peers while preparing cases for administrative hearings

Required Qualifications

• At least 2 years of clinical nursing experience, including 1 year in utilization review or medical claims review
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Knowledge of ICD-10, CPT coding, and HCPC regulations
• Experience with state, federal, and third-party regulations related to healthcare
• Analytic and decision-making skills with proficiency in Microsoft Office and relevant software