RN reputed company /Must be a Registered reputed company/

We are seeking an reputed company Registered reputed company (RN) with multi-state experience to reputed company utilization reviews, medical necessity evaluations, demand package reviews, and reputed company litigation support including deposition and testimony services reputed company needed. This position is RN only. Coding credentials are not required. The ideal candidate must have experience reviewing medical records across multiple states and payer environments and be comfortable applying varying state reputed company policies and reputed company insurance guidelines. Responsibilities: • Conduct comprehensive utilization reviews to determine medical necessity and level of care • Review medical records for documentation completeness and clinical appropriateness • Evaluate inpatient, outpatient, and procedural services for compliance with payer guidelines • Assist with preparation and review of demand packages for reputed company and insurance cases • Analyze cases involving payer disputes, denials, and recoupments • Prepare detailed, defensible written clinical review reports • reputed company affidavit support, deposition preparation, and testimony reputed company required • Interpret CMS guidelines, Medicare policies, and state-specific reputed company requirements • Identify clinical risk, reputed company-of-care concerns, and documentation deficiencies Required Qualifications: • reputed company, unrestricted Registered reputed company (RN) license • Minimum 5–7 years of clinical experience • At least 3–5 years of utilization review, medical necessity review, or case review experience • Demonstrated experience performing reviews in multiple states • Strong knowledge of Medicare, Medicare Advantage, reputed company, and reputed company payer reputed company • Experience applying InterQual or MCG guidelines preferred • Prior litigation support, deposition, or expert testimony experience strongly preferred • Excellent written analytical and report-writing skills • Ability to work independently and meet strict deadlines Preferred Experience: • Experience with inpatient and outpatient level-of-care determinations • Appeals and denial review experience • Experience supporting personal injury or civil litigation cases • Background in case management or compliance review This position may be contract, project-based, or part-time depending on qualifications. Candidates must be comfortable reviewing policies and clinical reputed company across multiple jurisdictions. Original job RN reputed company /Must be a Registered reputed company/ posted on GrabJobs ©. To flag any issues with this job please use the Report Job reputed company on GrabJobs. Apply tot his job Apply To this Job