Registered Nurse Medical Reviewer

Job Summary

A company is looking for a Medical Review Nurse II - SNF/MDS.

Key Responsibilities:

• Auditing claims for medically appropriate services in inpatient and outpatient settings
• Documenting findings and generating letters articulating audit results
• Collaborating with the audit team to identify vulnerabilities and improve medical policies

Required Qualifications:

• Active unrestricted RN license in good standing
• Minimum of five (5) years diversified nursing experience in inpatient or outpatient settings
• One (1) or more years' experience in medical records review
• One (1) or more years' experience in health care claims with expertise in ICD-9/ICD-10 and HCPCS/CPT coding
• Strong preference for experience in utilization review for an insurance company or similar organization