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Registered Nurse Medical ReviewerVirtualVocations • Athens, Georgia, United States
Registered Nurse Medical Reviewer

Registered Nurse Medical Reviewer

VirtualVocations • Athens, Georgia, United States
4 days ago
Job type
  • Full-time
Job description
To support the review of claims and provider appeals, the full-time Remote Clinical Medical Review Nurse will analyze medical information, assess claims eligibility, and participate in medical policy meetings while utilizing critical thinking and nursing judgment. Key responsibilities Receives and analyzes professional and institutional claims to determine eligibility for benefits and support claims processing Provides pricing for procedure codes and interprets medical information using CPT and HCPCS manuals Conducts medical underwriting and risk assessment for potential subscribers and participates in relevant medical policy discussions Required qualifications High School Diploma or GED Current RN - Registered Nurse state licensure or compact state licensure in VA, DC, or MD Minimum of 3 years acute clinical experience, with previous case management or utilization review experience Preferred Bachelor's degree in Nursing Preferred Certified Coding Professional (Inpatient) certification
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Registered Nurse Medical Reviewer • Athens, Georgia, United States

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