Tennessee Licensed RN Medical Reviewer

Job Summary

To support medical claims processing, the full-time Tennessee Licensed RN Medical Reviewer will perform medical reviews, document decisions based on clinical guidelines, and provide guidance to LPN team members while working remotely during standard business hours.

Key responsibilities

• Conduct medical claim reviews for complex services, preauthorization requests, and appeals
• Determine medical necessity and appropriateness for coverage and reimbursement
• Educate staff on medical reviews, terminology, and coding procedures in accordance with guidelines

Required qualifications

• Associate's degree in a job-related field or graduate of an accredited School of Nursing
• Active RN licensure in the state hired or an active compact multistate RN license
• Two years of clinical experience
• Working knowledge of Microsoft Office and word processing software
• Ability to handle confidential information with discretion