Illinois and Wisconsin RN Medical Claim Reviewer
Job Summary
A company is looking for a Medical Claim Review Nurse (RN) Remote IL & WI.
Key Responsibilities
- Conducts clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing
- Identifies quality of care issues and assists with complex claim reviews
- Documents findings and provides clinical support for denial or modification of payment decisions
Required Qualifications
- Graduate from an Accredited School of Nursing
- Minimum 3 years of clinical nursing experience
- Minimum 1 year of experience in Utilization Review and/or Medical Claims Review
- Active, unrestricted State Registered Nursing (RN) license in good standing
- Familiarity with state/federal regulations
COMPLETE JOB DESCRIPTION
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