State Licensed Medical Review Nurse

Job Summary

A company is looking for a Medical Review Nurse II - Commercial Home Health.

Key Responsibilities:

• Audit claims for medically appropriate services and document findings
• Generate letters articulating audit findings and support them during the appeals process
• Collaborate with the audit team and clients to improve medical policies and minimize appeals

Required Qualifications:

• Active unrestricted RN license in good standing
• Minimum of five years of diversified nursing experience in inpatient or outpatient settings
• One or more years of experience performing medical records review
• One or more years of experience in health care claims with expertise in coding and billing
• Strong preference for experience in utilization review for an insurance company or similar organization