Nebraska Licensed Medical Review Specialist

Job Summary

A company is looking for a Medical Review Specialist to perform medical reviews and ensure compliance with regulations and policies.

Key Responsibilities

• Conduct accurate and timely medical reviews of claims and preauthorizations
• Ensure compliance with State and Federal regulations and company mandates
• Collaborate with healthcare providers and internal teams to promote effective care and resource use

Required Qualifications

• Associate degree in nursing or Certified Practical Nurse with three years of clinical experience
• Current, unrestricted Registered Nurse or Licensed Practical Nurse license from Nebraska or participating consortium state
• Bachelor's degree in a healthcare field (preferred)
• Certification in Managed Care (preferred)
• Experience in medical review or utilization management (preferred)