Medical Review Nurse (Phoenix)
I3 INFOTEK INCPhoenix, AZ, USjob_description.job_card.variable_hours_ago
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job_description.job_card.job_descriptionMedical nursing practice, case management, utilization review protocols. Managed care processes and healthcare delivery systems. Coding : CPT, HCPCS, ICD-9; InterQual criteria; CCI. Statistical analysis and reporting. Good written and verbal communication, organizational skills, team collaboration. Ability to work independently and virtually. Active RN license in Arizona. Behavioral Health experience (preferably outpatient). Fingerprint Clearance Card (facility may initiate if candidate does not have one). High school diploma and experience in healthcare delivery systems. Experience in concurrent and retrospective review. Knowledge of InterQual, CCI, HCPCS, CPT coding, managed care. Certification in CPT coding a plus. Resume RN License Level 1 Fingerprint Clearance Card R2R / Cover Letter Verification of work location
Position Overview :
The Medical Review Nurse . The role ensures claims meet emergency criteria, medical necessity, and correct coding, coordinating with providers for second-level reviews as needed.
Key Responsibilities :
- Perform claims review / adjudication using industry standards.
- Determine if claims meet emergency criteria, medical necessity, and correct coding (CPT / HCPCS / Revenue codes).
- Evaluate appropriate level of care and length of stay.
- Prepare reports, analyze trends, and savings.
- Participate in research and special projects.
- Coordinate with providers and internal teams as required.
Knowledge & Skills Required :
Requirements :
Preferred :
Compliance Documents (Submit in one PDF) :
Specialty :
Medical Claims Review / Utilization Review / Managed Care Nursing
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Medical Review Nurse • Phoenix, AZ, US