Job Summary
A healthcare company is in need of a Remote Clinical Review Nurse.
Core Responsibilities of this position include:
- Reviewing documentation and making clinical determinations for payment supporting claims
- Applying clinical knowledge to assess and ensure services/items billed are reasonable and necessary
Must meet the following requirements for consideration:
- Current unrestricted RN license required
- Two (2) years’ clinical experience
- Ability to comprehend medical policy and criteria to clearly articulate health information required
- Demonstrated prioritization, problem solving, and organization skills
- Preferred experience in Hospice and Home Health/ Fraud detection
- Excellent communication skills
