Nebraska Licensed Medical Review Specialist

Job Summary

A company is looking for a Medical Review Specialist I.

Key Responsibilities

• Perform medical reviews to ensure compliance with contracts, regulations, and policies
• Conduct timely and accurate medical reviews of claims, preauthorizations, and customer service inquiries
• Collaborate with healthcare providers and internal teams to promote high-quality, cost-effective care

Required Qualifications

• Associate degree in nursing or Certified Practical Nurse with three years of clinical experience
• Current, unrestricted Registered Nurse or Licensed Practical Nurse license from Nebraska or participating consortium state
• Bachelor's degree in a healthcare field preferred
• Certification in Managed Care is a plus
• Experience in medical review or utilization management is preferred