Nebraska Licensed Medical Review Specialist

A company is looking for a Medical Review Specialist : Post Service.

Key Responsibilities

Perform medical review to ensure compliance with contracts, regulations, and medical policies

Conduct accurate and timely medical reviews of claims, preauthorizations, and customer service inquiries

Collaborate with healthcare providers and internal teams to promote high-quality, cost-effective care

Required Qualifications, Training, and Education

Associate degree in nursing or Certified Practical Nurse with three years of clinical experience

Current, unrestricted Registered Nurse or Licensed Practical Nurse license from Nebraska or participating consortium state

Bachelor's degree in a healthcare field (preferred)

Certification in Managed Care (preferred)

Experience in medical review or utilization management (preferred)