State Licensed Clinical Claims Nurse

Job Summary

A company is looking for a Clinical Claims Nurse.

Key Responsibilities

• Analyze medical records and case files to produce objective summaries for dispute resolutions
• Make evidence-based decisions in alignment with legal statutes and clinical standards
• Respond to issues raised by patients, beneficiaries, or healthcare providers involved in appeals

Required Qualifications

• Associate's degree or higher in a healthcare-related field from an accredited institution
• LPN or RN License
• Minimum of three years' experience in medical appeals or clinical review
• Background in Nursing, Physical Therapy, Occupational Therapy, or Respiratory Therapy
• Preferred experience with patient-provider dispute resolution processes