Registered Nurse Medical Reviewer

Job Summary

A company is looking for a Registered Nurse Medical Reviewer II for their Durable Medical Equipment Medicare Medical Review team.

Key Responsibilities

• Perform medical claim reviews to determine medical necessity and eligibility under Medicare guidelines
• Educate internal and external staff on medical reviews, terminology, and coverage determinations
• Participate in quality control activities and provide guidance to team members

Required Qualifications, Training, and Education

• Active, unrestricted RN licensure in the state of hire or compact multistate RN license
• Associate's degree in a job-related field or graduate of an accredited school of nursing
• Two years of clinical nursing experience
• One year of medical review experience preferred
• Experience in Durable Medical Equipment (DME) is preferred