MCS Health, a leader in healthcare reimbursement integrity, seeks a Clinical Review Nurse to evaluate post-service and pre-payment claims for medical necessity, coding accuracy, and policy compliance. The role requires clinical judgment and familiarity with CMS guidelines, coding rules, and reimbursement concepts.
Responsibilities include reviewing complex records, communicating with providers, and supporting payment integrity initiatives while ensuring accurate determinations and adherence to
#J-18808-LjbffrClinical Review Nurse Specialist in san juan at Unknown Company
This position is listed as full time and onsite.