West Virginia Licensed Medical Review Nurse

Job Summary

A company is looking for a Medical Necessity Review Nurse.

Key Responsibilities

• Evaluate requested services for medical necessity using payer criteria and clinical guidelines
• Review medical records to support the clinical picture and complexity of patient care
• Research and prepare appeal files in response to preservice clinical denials

Required Qualifications, Training, and Education

• Associate degree in Nursing or bachelor's degree in nursing with NCLEX-RN, or Licensed Practical Nurse with NCLEX-PN
• Three years of experience in direct patient care or hospital revenue cycle and authorization management
• Registered Nurse or Licensed Practical Nurse preferred
• Prior medical necessity review experience preferred