Job Summary

A provider of enterprise solutions and services is searching for a person to fill their position for a Telecommute Medical Review Specialist III.

Must be able to:

• Perform comprehensive medical record and claims review
• Utilize electronic health information imaging and inputs medical review decisions
• Utilize internet and intranet sources for policy verification

Required Skills:

• Must have and maintain a valid state driver’s license for the state of residence
• 3 years clinical experience as a Registered Nurse
• 4 years federal and local policy applications in relation to insurance procedures for medical necessity
• Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
• Ability to keep sensitive and confidential material private
• Must have no adverse actions pending or taken against him/her by any State or Federal licensing board