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 reconsideration or dispute resolution
• Make evidence-based decisions in compliance with legal statutes, regulations, and clinical standards
• Address issues presented by patients, beneficiaries, or healthcare providers involved in appeals or disputes

Required Qualifications

• Associate's degree or higher in a healthcare-related field from an accredited institution
• LPN or RN License
• Minimum of three (3) years' experience in medical appeals, dispute resolution, or clinical review
• Background in Nursing, Physical Therapy, Occupational Therapy, or Respiratory Therapy
• Possession of a coding certification is a plus