Texas Licensed Professional Review Nurse

Job Summary

A company is looking for a Professional Review Nurse III.

Key Responsibilities

• Identify and communicate issues of concern regarding the review process to relevant parties
• Collect and analyze data to assess the appropriateness of billing and treatment plans
• Document work and conclusions in the designated computer program

Required Qualifications and Education

• Current licensure as a Registered Nurse with a minimum of 4 years of clinical experience
• Minimum of an Associate Degree in Nursing with knowledge of C.P.T. and I.C.D.10 codes preferred
• Medical bill auditing experience preferred
• Experience in clinical areas such as O.R., I.C.U., C.C.U., E.R., and orthopedics preferred
• Experience in prospective, concurrent, and retrospective utilization review preferred