Clinical Adjudicator, RN
Job Summary
Reviewing Medicare Part A appeals, the full-time Clinical Adjudicator, RN will render medical necessity determinations, resolve technical issues, and conduct case reviews in a remote setting.
Key responsibilities
- Review favorable and partially favorable determinations in accordance with applicable regulations
- Render medical necessity determinations for assigned cases
- Conduct reviews of cases or sites to summarize facts and assess identified issues
Required qualifications
- Bachelor's degree required
- Active RN license required
- Minimum 2 years of clinical experience required with RN license
- Commitment to a training schedule of 8:00am - 4:30pm EST Monday - Friday
- Experience with medical records preferred
Complete Job Description
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