RN Licensed Clinical Claims Nurse

Job Summary

A company is looking for a Clinical Claims Nurse.

Key Responsibilities

• Reviews medical records and writes clear, concise dispute resolution decisions
• Makes independent decisions based on medical evidence and regulations
• Conducts research to support accurate and well-supported decisions

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 setting
• Experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy preferred
• Demonstrated experience in writing appeal or payment determinations preferred