Georgia Licensed RN Medical ReviewerVirtualVocations • Bridgeport, Connecticut, United States
Georgia Licensed RN Medical Reviewer
VirtualVocations • Bridgeport, Connecticut, United States
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
A company is looking for an RN Medical Reviewer III to perform medical reviews and support medical claims.
Key Responsibilities
Perform medical claim reviews and determine medical necessity based on clinical information and guidelines
Educate staff on medical reviews, terminology, and coverage determinations
Participate in quality control activities and provide guidance to team members
Required Qualifications, Training, and Education
Associate's degree in a job-related field
Active, unrestricted RN licensure in the state of hire or compact multistate RN license
2 years clinical experience plus 1 year in utilization / medical review or 3 years clinical experience
Working knowledge of word processing software
Ability to work independently and prioritize effectively
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