Illinois Wisconsin Licensed Review Nurse

Job Summary

A company is looking for a Medical Claim Review Nurse (RN) to work remotely in Illinois and Wisconsin.

Key Responsibilities

• Conducts clinical reviews of medical claims 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 payment decision modifications

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing
• Minimum 3 years of clinical nursing experience
• At least 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 and federal regulations