Skills Required:

Registered Nurse, Medical Record Review, Utilization Review, Risk Pool Handling, Medical Claims Processing, Medical Claims Auditing, Medical Claims Resolutions

Job Description:

Medical Record Review Nurse - Utilization Review RN

If you are a Registered Nurse with at least one year of experience in utilization review or a managed setting, please read on!

What you need for this position:

* Licensure as a Registered Nurse
* At least one year of experience in utilization review or a managed setting
* Risk pool handling experience is required

What you'll be doing:

* Resolve, audit, process claims for clinically related issues
* Review, process, audit claims for payment and appropriateness of charges
* Screen, audit, process claims of specific criteria for appropriate payment
* Visit providers as necessary to compare billed charges to medical record
* Support Accounting Dept. to determine liability for out-of-plan medical services
* Perform special projects, reconciliations, research, and analysis relating to utilization and cost of medical services
* Recommend/implement innovative strategies to retain members, contain medical costs, and improve efficiency

What's in it for you:

* Competitive salary
* Great Benefits package

So, if you are a Registered Nurse with at least one year of experience in utilization review or a managed setting, please apply today!

Must be authorized to work in the United States on a full-time basis for any employer.