Job Summary
A healthcare company is seeking a Telecommute Retrospective Prepayment Review Nurse.
Core Responsibilities Include:
- Documenting determination of medical necessity on claims referred by automated edits
- Documenting determination on cases where preauthorization was required but not obtained
- Applying prepayment guidelines to assure payment for only medically necessary and appropriate services
Must meet the following requirements for consideration:
- Current RN license in state where employed
- Must successfully receive interim approval for government security clearance (eQIP)
- 3 years of experience in clinical RN setting
- Good verbal and written communication skills