Registered Nurse - Medical Review

Job Summary

A company is looking for a Medical Review and Appeals - RN.

Key Responsibilities

• Perform reviews of inpatient, outpatient, and ancillary services to ensure medical necessity and appropriateness of care
• Analyze and respond to retrospective review requests and appeals in compliance with regulatory standards
• Coordinate discharge planning and resolve issues related to benefits and member eligibility

Required Qualifications

• Bachelor's degree in nursing, allied health, business, or a related field preferred
• Current unrestricted Registered Nurse license required
• Minimum two (2) years of clinical experience in areas such as acute patient care or case management
• Certification in Case Management may be preferred based on department assignment
• One (1) year of experience in a health insurance plan or managed care environment preferred