Registered Nurse Coder

Job Summary

A company is looking for a RN Coder (Must be a Registered Nurse).

Key Responsibilities

• Conduct comprehensive utilization reviews to determine medical necessity and level of care
• Review medical records for documentation completeness and clinical appropriateness
• Assist with preparation and review of demand packages for legal and insurance cases

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license
• Minimum 5-7 years of clinical experience
• At least 3-5 years of utilization review or case review experience
• Demonstrated experience performing reviews in multiple states
• Strong knowledge of Medicare, Medicaid, and commercial payer criteria