Registered Nurse Medical Reviewer

Job Summary

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

Key Responsibilities:

• Conducting audits on claims for medically appropriate services in inpatient and outpatient settings
• Documenting findings and generating letters that articulate audit results
• Collaborating 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 inpatient or outpatient settings
• One or more years of experience in medical records review
• One or more years of experience in health care claims with expertise in ICD-9/ICD-10 and CPT coding
• Strong preference for experience in utilization review for insurance companies or similar organizations