RN Medical Review Nurse

A company is looking for a Medical Review Nurse II - Clinical Validation.

Key Responsibilities :

Conducting audits of medical claims for appropriate services in inpatient and outpatient settings

Documenting findings and generating letters that articulate audit results

Collaborating with the audit team and clients to improve medical policies and minimize appeals

Required Qualifications :

Active unrestricted RN license in good standing

Minimum of five years of diversified nursing experience in inpatient or outpatient settings

At least one year of experience in medical records review

One year of experience in healthcare claims with expertise in ICD-9 / ICD-10 coding

Strong preference for experience in utilization review for insurance companies or similar organizations