Ohio Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Appeal & Claim Review Nurse II.

Key Responsibilities

• Independently evaluates medical claims and appeal cases to assess service appropriateness
• Summarizes medical information for physician review and generates written status updates
• Acts as a resource for providers and collaborates with internal departments to ensure appropriate member care

Required Qualifications

• Graduate of a registered nursing program approved by the Ohio State Nursing Board; Bachelor's degree preferred
• 3 years of experience as a Registered Nurse in acute care, critical care, or relevant clinical settings
• Registered Nurse with a current State of Ohio unrestricted license
• Familiarity with clinical claim management, medical terminology, and healthcare regulations
• PC and keyboarding proficiency; Intermediate Microsoft Office skills