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