Clinical Claims Review RN

Job Summary

A company is looking for a Clinical Claims Review RN specializing in readmissions, with the option to work remotely.

Key Responsibilities

• Perform clinical coverage review services, interpreting mandates and clinical information
• Communicate benefit determinations and collaborate with Medical Directors and non-clinical partners
• Work independently within a self-directed team to meet performance metrics

Required Qualifications

• Current, unrestricted RN license in the state of residency
• 3+ years of RN experience in an inpatient/acute setting
• Proficient computer skills including Microsoft Windows, Word, Excel, Teams, and Outlook
• Access to secure high-speed internet at home
• Dedicated, distraction-free workspace at home