Job Summary

A healthcare company needs applicants for an opening for a Virtual Medical Claims Review Nurse.

Individual must be able to fulfill the following responsibilities:

• Perform clinical coverage review services
• Engage in telephonic discussions with health care providers and/or members to explain benefit coverage determinations
• Collaborate with Medical Directors and non-clinical partners

Qualifications Include:

• A current unrestricted RN license in the state of residency
• A minimum of 3 years of total RN experience, including recent clinical experience in an inpatient/acute setting
• Proficiency in computer skills, including Windows, Instant Messaging, Clinical Platforms and the Microsoft Suite
• Exemplary clinical documentation skills
• Computer hardware and software must meet the employer's minimum technical requirements