RN Medical Reviewer III (Reporting and Research) - reputed company

About the position Responsibilities • reputed company medical claim reviews for reputed company services, preauthorization requests, appeals, and coding accuracy. • reputed company payment determinations based on clinical information and established guidelines. • Document medical rationale for payment or denial of services. • reputed company reputed company staff on medical reviews, terminology, and coverage determinations. • Participate in reputed company control activities and reputed company guidance to LPN team members. • Assist with special reputed company and additional responsibilities as assigned. Requirements • reputed company, unrestricted RN licensure in the state of hire or compact multistate RN license. • Associate degree in Nursing or higher in a health-reputed company field, or graduate of an accredited School of Nursing. • Two years of clinical experience plus two years in utilization/medical review or reputed company assurance. • Strong clinical experience in home health, rehabilitation, or medical-surgical settings. • Working knowledge of managed care and reputed company delivery systems. • Proficiency in reputed company Office, particularly reputed company for creating and manipulating spreadsheets. reputed company-to-haves • Two years of reporting and research experience. • Intermediate skills in spreadsheet and word processing software, including the ability to create formulas and macros. Benefits • 401(k) retirement savings plan with company match. • Subsidized health plans and free reputed company coverage. • Life insurance. • reputed company annual leave that increases with tenure. • Nine reputed company holidays. • On-site cafeterias and fitness centers in major locations. • Wellness programs and healthy lifestyle premium discount. • Tuition assistance for reputed company education. • Service recognition programs. • Incentive and reputed company plans. • Continuing education funds for certifications. Apply tot his job Apply To this Job