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Registered Nurse / RN - Medical Review (5678)

Claims Review Mgmt | Nashville, TN | Contract

Job Description
Registered Nurse / RN - Medical Review
Work Location: Nashville, TN

InGenesis is currently seeking a Registered Nurse / RN to perform Medical Review of clinical information using established criteria or clinical guidelines. In this role, you will provide support and review of medical claims and utilization practices.

This is a potential REMOTE opportunity local candidates – once trained and high performance is demonstrated! Apply today and we’ll reach out to answer any questions you may have.

Job Duties
• Perform reviews for complex service claims, pre-authorizations, appeals, referrals for potential fraud, etc.
• Make charge payment determinations.
• Determine medical necessity and appropriateness of services.
• Document justification of payments or denials.
• Provide guidance, direction, and input as needed.
• Provide education to non-medical staff.
• Perform other duties as assigned.

Minimum Qualifications
• Current Registered Nurse / RN license in the State of South Carolina.
• Associate degree in Nursing or graduate from accredited nursing school.
• 2+ years of clinical experience.
• Experience in utilization or medical review, preferred.
• Potential to work remote after 6 months onsite and fully trained in role.