California Licensed Clinical Claims Nurse

Job is Expired

Location: Remote

Compensation: Hourly

Reviewed: Thu, Jun 12, 2025

Job Category: Healthcare

Employer Type: Staffing Agency

Career Level: Experienced

Job Summary

A company is looking for a Medical Claim Review Nurse.

Key Responsibilities

Review medical records and claims for medical necessity and coding accuracy
Conduct retrospective audits including DRG Validation, Level of Care, and Readmission reviews
Collaborate with Medical Directors and assist Utilization Management teams

Required Qualifications

Active, unrestricted RN license
3+ years of clinical nursing experience
Experience with medical claims review, auditing, or utilization management preferred
Familiarity with MCG/InterQual or willingness to train

COMPLETE JOB DESCRIPTION

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Job is Expired

Company Overview

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