Massachusetts Licensed Clinical Review RN

Job Summary

Performing clinical claim reviews, the part-time Massachusetts Licensed Clinical Review RN will verify coding accuracy and charge correctness, ensuring compliance with state and federal guidelines while working remotely.

Key responsibilities:

• Conduct clinical reviews of claims against medical records to assess support for claims
• Maintain productivity and accuracy standards while documenting findings and adhering to compliance policies
• Assist in resolving claims to support negotiations and the appeals process as needed

Required qualifications:

• Associate's degree
• Active and unrestricted RN license in the state of residence
• 2+ years of clinical experience in an acute care setting
• 1+ years of experience in Utilization Management, claim review, or medical record review
• Intermediate proficiency in Microsoft Office applications