Compact Licensed RN Medical Claims Review

Job Summary

A company is looking for a Registered Nurse RN Medical Claims Review Healthcare Compact License.

Key Responsibilities

• Perform retrospective authorization reviews and determine medical necessity of requests
• Utilize decision-making skills to evaluate coverage for healthcare services and document all review activities
• Refer cases to review physicians when necessary and identify potential quality issues or fraud cases

Required Qualifications

• Current unrestricted RN license in the state of residency (compact license preferred)
• 2+ years of experience in managed care, Utilization Review, or Case Management, or 5+ years of nursing experience
• Proficient in Microsoft Word, Excel, and Outlook