Registered Nurse Medical Reviewer

Job Summary

A company is looking for a Medical Review Nurse II - Commercial DME.

Key Responsibilities:

• Audit claims for medically appropriate services in inpatient and outpatient settings
• Document findings and generate letters articulating audit results
• Collaborate with the audit team to improve medical policies and reduce appeals

Required Qualifications:

• Active unrestricted RN license in good standing
• Minimum of five years of diversified nursing experience in direct care
• One or more years of experience in medical records review
• One or more years of experience in health care claims with expertise in coding
• Strong preference for experience in utilization review for an insurance company