Working remotely in a dynamic environment, the part-time State Licensed Medical Review Nurse will perform medical claims audit reviews for government clients, focusing on both retrospective and prepayment audits while collaborating with a multi-location team. Key Responsibilities: Auditing claims for medically appropriate services in inpatient and outpatient settings while applying relevant medical review guidelines Documenting findings and generating letters that articulate audit results Collaborating with the audit team to identify vulnerabilities and improve medical policies and provider education 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 performing medical records review One year of experience in health care claims with expertise in ICD-9/ICD-10 coding and medical billing Strong preference for experience in utilization review for insurance companies or similar organizations
State Licensed Medical Review Nurse in workfromhome at Unknown Company
This position is listed as part time and able to be worked remotely.