State Licensed Medical Review Nurse

Job Summary

A company is looking for a Medical Review Nurse II - Home Health.

Key Responsibilities:

• Conduct medical claims audit reviews for inpatient and outpatient services
• Document findings and generate letters articulating audit results
• Collaborate with the audit team and support findings during the appeals process

Required Qualifications:

• Active unrestricted RN license in good standing
• Minimum of five years of diversified nursing experience in inpatient or outpatient settings
• At least one year of experience in medical records review
• One year of experience in health care claims with expertise in coding and billing
• Strong preference for experience in utilization review for insurance companies or similar organizations