Job Description

We're seeking a highly motivated Medical Claims Reviewer to join our growing team! This is an excellent opportunity for a registered nurse with experience in utilization review or medical review to leverage their clinical skills and contribute to ensuring accurate healthcare claims processing.

What You'll Do:

Analyze medical claims using established criteria and guidelines.
Determine medical necessity and appropriateness of services.
Make informed decisions regarding payment or denial of claims.
Collaborate with internal and external staff on medical terminology and coding procedures.
Contribute to quality control initiatives and support team objectives.
Assist with special projects and tasks as assigned.
What We're Looking For:

Active RN license from the US and state of hire (compact license preferred).
Bachelor's degree in Nursing (Master's degree strongly preferred).
Minimum 5 years of clinical experience as a Registered Nurse.
Minimum 3 years of experience in utilization review, medical review, quality assurance, or home health.
Strong analytical and critical thinking skills.
Excellent communication and interpersonal skills.
Ability to work independently, prioritize effectively, and make sound decisions.
Proficient in Microsoft Office Suite.
What We Offer:

Competitive salary ($67,700 annually) with benefits package (health, dental, vision, 401(k) with matching, paid time off, etc.).
Work-from-home opportunity with occasional travel required.
Positive and collaborative work environment.
Opportunity to make a real impact on healthcare delivery.
Employment Type: Full-Time
Salary: $ 67,700.00 Per Year

Job Tags

Full time, Work from home,

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