State Licensed Medical Claim Review Nurse

Job Summary

A company is looking for a Medical Claim Review Nurse (RN).

Key Responsibilities

• Perform clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing
• Identify and report quality of care issues while assisting with complex claim reviews
• Document clinical review summaries and provide training and support to clinical peers

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing
• Minimum 3 years of clinical nursing experience
• Minimum 1 year of experience in Utilization Review and/or Medical Claims Review
• Active, unrestricted State Registered Nursing (RN) license in good standing
• Bachelor's Degree in Nursing or Health Related Field preferred