Tennessee Licensed Medical Reviewer RN

Job Summary

A company is looking for a Registered Nurse Medical Reviewer II (DME Medicare).

Key Responsibilities

• Perform medical claim reviews and make payment determinations based on clinical information and established guidelines
• Document medical rationale for service coverage and educate staff on medical reviews and coding procedures
• Participate in quality control activities and provide guidance to team members

Required Qualifications

• Education: Associate degree in Nursing or Graduate of an accredited School of Nursing
• Work Experience: Two years of clinical experience as a Registered Nurse
• License: Active RN licensure in the state hired or active compact multistate RN license
• Working knowledge of word processing software and Microsoft Office
• Ability to work independently and prioritize effectively