Registered Nurse, Clinical Reviewer
Job Summary
A company is looking for a Registered Nurse, Clinical Waste & Abuse Reviewer.
Key Responsibilities
- Evaluate medical records, claims, and documentation for medical necessity and coding accuracy
- Identify waste and abuse trends and collaborate with various teams to support clinical decisions
- Conduct reviews across multiple products to enhance pre-payment accuracy and escalate high-risk cases
Required Qualifications
- Current, unrestricted Registered Nurse (RN) license
- Minimum of 2 years of clinical experience in an acute care setting
- Associate degree in Nursing or Nursing Diploma
- Strong clinical judgment and analytical thinking
- Ability to manage multiple reviews with accuracy and efficiency
COMPLETE JOB DESCRIPTION
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