State Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Medical Review Nurse (Remote).

Key Responsibilities

• Review and analyze professional and institutional claims using nursing clinical judgment and corporate policies
• Conduct high-level research on medical policies and assess their impact
• Participate in medical policy meetings and collaborate with medical directors and committees

Required Qualifications

• 3 years of acute clinical experience, including case management or utilization review
• High School Diploma or GED
• Registered Nurse (RN) licensure required upon hire
• Preferred: Bachelor's degree in Nursing
• Preferred: Experience with clinical decisions related to claims and appeals in a health payer organization