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Registered Nurse Medical Claims Review

7/10/2025

No location specified

Job Summary

A company is looking for a Registered Nurse RN Medical Claims Review Healthcare Compact License.

Key Responsibilities
  • Perform retrospective authorization reviews and determine medical necessity of requests
  • Utilize decision-making skills to assess coverage for healthcare services and manage medical claims calls
  • Document all review activities, communicate outcomes, and refer cases as necessary
Required Qualifications
  • Current unrestricted RN license in the state of residency (compact license preferred)
  • 2+ years of experience in managed care, Utilization Review, or Case Management, or 5+ years of nursing experience
  • Proficient in Microsoft Word, Excel, and Outlook

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