Medical Reviewer III - RN Stop Loss

Job Summary

A company is looking for a RN Medical Reviewer III for a remote position.

Key Responsibilities:

• Perform medical claim reviews for various services and determinations
• Educate staff on medical reviews, terminology, and coding procedures
• Participate in quality control activities and provide guidance to team members

Required Qualifications, Training, and Education:

• Active, unrestricted RN licensure in the state of hire
• Associates in a job-related field or Graduate of Accredited School of Nursing
• Two years clinical experience plus one year utilization/medical review, or three years clinical experience
• Working knowledge of managed care and health care delivery systems
• Proficiency in Microsoft Office software