South Carolina Licensed RN Reviewer
VirtualVocationsHuntington Beach, California, United Statesjob_description.job_card.variable_hours_ago
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job_description.job_card.job_description
A company is looking for an RN Medical Reviewer II to perform medical reviews and support medical claims processing.
Key Responsibilities
Conduct medical claim reviews for complex services and determine coverage and reimbursement based on established criteria
Document medical rationale for payment or denial of services and provide education on medical reviews and coding procedures
Participate in quality control activities and assist with special projects as assigned by management
Required Qualifications, Training, and Education
Associate Degree in Nursing or graduate of an accredited School of Nursing
Two years of clinical experience
Active RN licensure in the state hired or an active compact multistate RN license
Preferred experience in medical review or utilization review
Proficient in Microsoft Office
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South Carolina • Huntington Beach, California, United States
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