RN Medical Reviewer III

Job Summary

A company is looking for an RN Medical Reviewer III (Reporting and Research).

Key Responsibilities

• Perform medical claim reviews for complex services and determine medical necessity
• Educate internal and external staff on medical reviews and coding procedures
• Participate in quality control activities and assist with special projects

Required Qualifications, Training, and Education

• Active, unrestricted RN licensure from the United States or compact multistate license
• Associate degree in Nursing, or a bachelor's degree in a health-related field
• Two years of clinical experience plus two years in utilization/medical review or quality assurance
• Knowledge of managed care and healthcare delivery systems
• Proficiency in Microsoft Office and spreadsheet software