Licensed Medical Review Nurse

Job Summary

Performing skilled nursing facility medical claims audits, the remote Medical Review Nurse II - SNF/MDS Auditor will review claims for appropriateness, document findings, and support the appeals process while collaborating with a multi-location audit team.

Key responsibilities:

• Auditing claims for medically appropriate services in skilled nursing facilities using relevant guidelines
• Documenting audit findings and generating letters to articulate results
• Collaborating with the audit team to improve medical policies and minimize appeals

Required qualifications:

• Active unrestricted RN license in good standing
• A minimum of five years of diversified nursing experience in inpatient or outpatient settings
• At least one year of experience with the MDS/RAI process
• One year of experience in medical records review
• Expertise in ICD-9/ICD-10 coding guidelines related to the MDS RAI process