Clinical Claim Review RN

Job Summary

A company is looking for a Clinical Claim Review RN.

Key Responsibilities

• Perform clinical reviews post service using established guidelines and clinical criteria
• Collaborate with Medical Directors and non-clinical partners while managing a heavy case load
• Adapt to a fast-paced, changing environment to improve member and provider experiences

Required Qualifications

• Current unrestricted RN license in the state of residency
• Minimum of 3 years RN experience, including clinical experience in an inpatient/acute setting
• Proficiency in computer skills, including Microsoft Suite
• Exemplary clinical documentation skills
• Ability to handle a fast-paced production environment and multiple review types