Clinical Claim Review RN

Job Summary

A company is looking for a Clinical Claim Review RN - Remote.

Key Responsibilities:

• Perform clinical reviews by interpreting state and federal mandates and applicable benefit language
• Collaborate with a self-directed team to meet performance metrics
• Communicate benefit determinations regarding coverage guidelines and reimbursement

Required Qualifications:

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