Remote Medical Review Nurse

Job ID: Available for Members

Location: Nationwide

Compensation: To Be Discussed

Staff Reviewed: Mon, Jan 28, 2019

Job Category: Healthcare, Nursing

Telecommute Level: Majority

Travel Requirements: Possible Travel

Weekly Hours: Full Time

Employment Status: Permanent

Employer Type: Employer

Career Level: Experienced

Job Summary

A company that provides technology-enabled recovery and related analytics services is searching for a person to fill their position for a Remote Medical Review Nurse.

Candidates will be responsible for the following:

  • Auditing claims for medically appropriate services provided in both inpatient and outpatient settings
  • Applying appropriate medical review guidelines, policies and rules
  • Generating letters articulating audit findings

Qualifications for this position include:

  • 3 years diversified nursing experience providing direct care in an inpatient or outpatient setting.
  • 1 or more years experience performing medical records review
  • 1 or more years experience in health care claims
  • Experience with utilization management systems or clinical decision making tools
  • Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding
  • Knowledge of insurance programs program, particularly the coverage and payment rules