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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