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California Licensed Claims Review NurseVirtualVocations • Alpharetta, Georgia, United States
California Licensed Claims Review Nurse

California Licensed Claims Review Nurse

VirtualVocations • Alpharetta, Georgia, United States
3 days ago
Job type
  • Full-time
Job description
Working remotely, the full-time California Licensed Claims Review Nurse will perform clinical reviews of formal appeals and provider disputes to ensure compliance with organizational policies and state and federal guidelines. Key responsibilities: Reviews claims for medical appropriateness, including provider contract status and benefit interpretation Documents denial reasons with appropriate specificity and ensures clarity in communication Maintains turnaround time for processing denials and appeals in accordance with federal and state guidelines Required qualifications: Graduation from an accredited school of nursing Active, unrestricted RN Nurse license through the State of California 1+ year of utilization management or quality improvement experience in a healthcare setting Basic Life Support for Healthcare providers certification Solid knowledge of Microsoft Office and familiarity with Medicare and health plan guidelines
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California Licensed Claims Review Nurse • Alpharetta, Georgia, United States

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