RN Senior Medical Reviewer - AL

Job Summary

A company is looking for an RN Senior Medical Reviewer - ALJ Clinician.

Key Responsibilities

• Lead and provide guidance to staff in medical review and utilization management
• Conduct second-level medical reviews of appeals and prepare ALJ position papers
• Ensure compliance with quality standards and participate in departmental quality reviews

Required Qualifications, Training, and Education

• Active, unrestricted RN licensure in the United States or compact multistate RN license
• Associate Degree in Nursing or graduate of an accredited School of Nursing
• Four years of clinical experience or a combination of clinical and medical review experience totaling four years
• Working knowledge of managed care and healthcare delivery systems
• Proficiency in Microsoft Office software