South Carolina RN Medical ReviewerVirtualVocations • Fontana, California, United States
South Carolina RN Medical Reviewer
VirtualVocations • Fontana, California, 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 II to perform medical reviews and support medical claims and utilization practices.
Key Responsibilities
Conducts medical claim reviews for complex services and preauthorization requests
Determines medical necessity and appropriateness for coverage and reimbursement
Educates staff on medical reviews, terminology, and coding procedures
Required Qualifications
Associate Degree in Nursing or graduation from an accredited School of Nursing
Valid, active, unrestricted RN licensure in the state of hire or active compact multi-state RN licensure
Two years of clinical nursing experience
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South Carolina • Fontana, California, United States
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