Job Summary
An information technology company is seeking a Remote Registered Nurse Medical Reviewer III.
Candidates will be responsible for the following:
- Reviewing the Master Policy List and the MR questionnaire for each State prior to the review of claims for that State
- Ensuring the MR department’s compliance with quality management system and ISO requirements
- Participating in QA and IRR monitoring
Applicants must meet the following qualifications:
- Active RN state licensure
- 4-9 years experience
- At least 4 years clinical experience in a medical/surgical setting
- At least 2 years of medical record audit experience
- Familiarity with Medicaid and/or CHIP program
- Critical thinking and analytical skills
