Job Summary
A healthcare company is in need of a Remote Initial Clinical Claim Utilization Review Nurse.
Must be able to:
- Provide clinical review and decision-making following specific clinical coverage position criteria
- Conduct clinical determinations and/or recommendations on both Pre-service and Post-service Inpatient and Outpatient services
- Conduct clinical appeal reviews for both level 1 and level 2 healthcare professionals
Position Requirements Include:
- Valid RN licensure without in the state of residency without any restrictions or stipulations
- 1 year of nursing experience
- Strong computer skills
- Strong typing skills
- Works well independently
- Strong problem solving and critical thinking skills