Job Summary
An information technology company is searching for a person to fill their position for a Remote Registered Nurse Medicaid Medical Reviewer III.
Candidates will be responsible for the following:
- Conducting medical record audits
- Conducting in-depth claims analysis
- Utilizing payer guidelines for coverage determinations
Applicants must meet the following qualifications:
- Active RN state licensure
- 4-9 years experience
- At least four (4) years clinical experience in a medical/surgical setting
- Familiarity with Medicaid and/or CHIP program
- At least two (2) years of medical record audit experience
- Have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
