Remote Medical Claims Review Nurse in San Antonio

This job has been removed

Location: Texas

Compensation: To Be Discussed

Staff Reviewed: Tue, Sep 21, 2021

This job expires in: 6 days

Job Category: Healthcare

Remote Level: 100% Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Job Summary

A global healthcare company is filling a position for a Remote Medical Claims Review Nurse in San Antonio.

Individual must be able to fulfill the following responsibilities:

  • Perform retrospective authorization reviews according to guidelines within a specific timeframe
  • Utilize decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services
  • Determine medical necessity of each request by applying appropriate medical criteria to first level reviews and utilizing approved evidenced based guidelines/criteria

Qualifications for this position include:

  • Current, unrestricted Texas RN license or compact state RN license
  • Proficient in PC software computer skills that include Microsoft Word, Excel and Outlook
  • 2+ years of experience in managed care, Utilization Review, Case Management OR 5+ years nursing experience

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