Tennessee Licensed Medical Reviewer

Job Summary

Reviewing medical records to determine medical necessity and eligibility under Medicare guidelines, the full-time Tennessee Licensed Medical Reviewer will work remotely, focusing on medical claim reviews, educating staff, and participating in quality control activities.

Key responsibilities:

• Perform medical claim reviews for complex services, preauthorization requests, and potential fraud cases
• Educate internal and external staff on medical reviews, terminology, and coding procedures
• Participate in quality control activities and provide guidance to team members

Required qualifications:

• Active RN licensure in the state hired or active compact multistate RN license
• Associate degree in a job-related field or graduate of an Accredited School of Nursing
• Two years of clinical nursing experience
• Working knowledge of Microsoft Office and ability to work independently
• Demonstrated analytical or critical thinking skills and good judgment