State Licensed Nurse Reviewer

A company is looking for a Nurse Reviewer.

Key Responsibilities

Conduct initial assessments of documentation from both initiating and responding parties

Review submitted documentation to identify missing documents and determine necessary actions for dispute resolution

Prepare documents for the arbitrator reviewer and collaborate with the legal team to facilitate dispute resolution

Required Qualifications

Active nursing license (minimum RN required)

Five years of full-time equivalent experience providing direct patient care

Ability to analyze clinical documentation and apply appropriate guidelines

Knowledge of claim review processes, including billing and CPT coding

Medical Coding Certification and experience with Utilization Review preferred