State Licensed Medical Review Nurse

Job Summary

A company is looking for a Medical Review Nurse II with a Government/Clinical Outpatient Focus.

Key Responsibilities:

• Perform audits on claims for medically appropriate services in inpatient and outpatient settings
• Document findings and generate letters detailing audit results
• Collaborate with the audit team and clients to improve medical policies and reduce appeals

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 ICD-9/ICD-10 and medical billing
• Preferred experience in utilization review for insurance companies or similar organizations