Wisconsin Licensed Medical Review Nurse

Job Summary

To support the evaluation of medical services under TRICARE policy, the full-time Wisconsin Licensed Medical Review Nurse will review medical records for service eligibility, analyze clinical documentation for appeals, and collaborate with internal teams and providers, with remote work options available in several states.

Key responsibilities

• Review authorization requests and evaluate medical records for compliance with TRICARE policy
• Analyze clinical documentation for disputed appeals and verify clinical necessity for medical review claims
• Gather and summarize clinical information to support second-level appeal reviews, collaborating with stakeholders as needed

Required qualifications

• U.S. Citizenship is required due to Department of Defense restrictions
• Bachelor's Degree in Nursing (BSN) or equivalent combination of education and experience
• Active Registered Nurse (RN) license in the state of practice or a compact nursing license
• 3 or more years of experience in healthcare, health policy, clinical research, or a related field
• Proven experience conducting research and analyzing information with strong critical thinking skills