Georgia Licensed RN Medical Reviewer

Job Summary

A company is looking for an RN Medical Reviewer III to perform medical reviews and support medical claims.

Key Responsibilities

• Perform medical claim reviews and determine medical necessity based on clinical information and guidelines
• Educate staff on medical reviews, terminology, and coverage determinations
• Participate in quality control activities and provide guidance to team members

Required Qualifications, Training, and Education

• Associate's degree in a job-related field
• Active, unrestricted RN licensure in the state of hire or compact multistate RN license
• 2 years clinical experience plus 1 year in utilization/medical review or 3 years clinical experience
• Working knowledge of word processing software
• Ability to work independently and prioritize effectively