Job Summary

A developer of payment processing products for the healthcare industry has a current position open for a Remote Nurse Reviewer.

Core Responsibilities of this position include:

• Reviewing and interpreting medical records and compares against criteria to determine appropriateness and reasonableness of care
• Documenting decisions and rationale to justify review findings or no findings
• Performing prior authorization, precertification, and retrospective reviews

Required Skills:

• Associates or Bachelor's degree in Nursing (active / unrestricted license)
• 5+ years' clinical experience in an inpatient setting
• 2 + years' utilization review experience or claims auditing experience
• Case Management experience highly preferred
• High level of proficiency in Milliman and Interqual guidelines
• Ability to analyze and evaluate medical information and to apply clinical review guidelines or judgement to make clinical determinations