California Licensed Review Nurse

Job Summary

A company is looking for a Professional Review Nurse.

Key Responsibilities

• Analyze medical services to assess the appropriateness of charges and medical care
• Collect and evaluate data to make informed decisions regarding billing and treatment plans
• Document findings and conclusions in designated software and communicate issues to relevant parties

Required Qualifications, Training, and Education

• Current Registered Nurse licensure with a minimum of 4 years clinical experience
• Associate Degree in Nursing with knowledge of C.P.T. and I.C.D.9 codes preferred
• Preferred medical bill auditing experience
• Experience in clinical areas such as O.R., I.C.U., C.C.U., E.R., and orthopedics preferred
• Preferred experience in utilization review (prospective, concurrent, retrospective)