Nevada Licensed Clinical Claims RN

A company is looking for a Clinical Claims Reviews RN - Remote.

Key Responsibilities

Conduct retrospective reviews for appropriateness of diagnostic procedures and coding levels

Evaluate medical necessity and determine appropriate levels of care for assigned claims

Prepare claims for medical director review and participate in special projects as assigned

Required Qualifications

Current, unrestricted RN license for the state of Nevada

2+ years of nursing experience in utilization review, case management, or clinical claims review

1+ years of experience working in a hospital or clinical setting

Proficiency with Microsoft Word, Excel, and Outlook