Texas Licensed Medical Review Nurse

Job Summary

A company is looking for a Remote Medical Review Nurse (RN) who must work in the CST time zone.

Key Responsibilities

• Facilitates clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing
• Reevaluates medical claims and records, applying clinical knowledge and regulatory guidelines
• Serves as a clinical resource for utilization management and provides training to clinical peers

Required Qualifications

• At least 2 years of clinical nursing experience, including 1 year in utilization review or medical claims review
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Knowledge of ICD-10, CPT coding, and HCPC regulations
• Experience working within applicable state and federal regulations
• Proficiency in Microsoft Office Suite and relevant software programs