State Licensed Medical Review Nurse

A company is looking for a Medical Review Nurse II - Government / Clinical Outpatient Focus.

Key Responsibilities :

Auditing claims for medically appropriate services in inpatient and outpatient settings

Documenting findings and generating letters articulating audit results

Collaborating with the audit team and clients to improve medical policies and workflows

Required Qualifications :

Active unrestricted RN license in good standing

Minimum of five (5) years of diversified nursing experience in inpatient or outpatient settings

One (1) or more years of experience in medical records review

One (1) or more years of experience in healthcare claims with expertise in ICD-9 / ICD-10 coding

Strong preference for experience in utilization review for insurance companies or similar organizations