Medical Claims Review Nurse

Location: Remote
Compensation: To Be Discussed
Staff Reviewed: Mon, Jun 03, 2024
This job expires in: 19 days

Job Summary

A company is looking for a Medical Claims Review Nurse.

Key Responsibilities:
  • Reviewing medical patient records against standard medical criteria
  • Performing clinical/medical reviews of retrospective medical claim reviews, medical claims, and previously denied cases
  • Identifying and reporting quality of care issues and serving as a clinical resource for various stakeholders
Required Qualifications, Training, and Education:
  • Three years of clinical appeals experience
  • One year of utilization review experience
  • DRG experience on resume preferred for interview consideration
  • BSN preferred for education
  • Active, unrestricted State Registered Nursing (RN) license in good standing required

COMPLETE JOB DESCRIPTION

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