Registered Nurse Medical Claims Review

Job Summary

A company is looking for a Registered Nurse RN Medical Claims Review Healthcare Compact License.

Key Responsibilities

• Perform retrospective authorization reviews according to guidelines within a specific timeframe
• Determine medical necessity of requests by applying appropriate medical criteria and guidelines
• Review, document, and communicate all Medical Claims Review activities and outcomes

Required Qualifications

• Current unrestricted RN license in the state of residency (compact license preferred)
• 2+ years of experience in managed care, Utilization Review, Case Management, or 5+ years nursing experience
• Proficient in PC software skills including Microsoft Word, Excel, and Outlook