State Licensed Medical Claim Review Nurse

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