RN Clinical Medical Review Nurse

Job Summary

A company is looking for a Clinical Medical Review Nurse (Remote).

Key Responsibilities

• Review and analyze professional and institutional claims to determine eligibility for benefits
• Provide pricing for procedure codes and interpret medical information using coding manuals
• Participate in medical policy meetings and collaborate with medical directors on special projects

Required Qualifications

• High School Diploma or GED
• 3 years of acute clinical experience, with case management or utilization review experience preferred
• RN - Registered Nurse state licensure required upon hire
• Bachelor's degree in Nursing preferred
• Experience in a healthcare payor organization handling appeals and grievances preferred