RN Licensed Clinical Claims Nurse

Job Summary

A company is looking for a Clinical Claims Nurse.

Key Responsibilities

• Review medical records and write clear, concise dispute resolution decisions
• Make independent decisions based on medical evidence and relevant regulations
• Conduct research to support accurate decision-making and stay updated on regulatory changes

Required Qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• RN or LLP license required
• Three years of experience in medical dispute resolution or related healthcare settings
• Experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy preferred
• Demonstrated experience in writing appeal or payment determinations preferred