Medical Reviewer

Key Responsibilities:

• Review a variety of claim types including Radiology, Ambulance, Physical Therapy, and Surgical.
• Use clinical information and Medicare guidelines to determine medical necessity and document decisions.
• Educate internal and external staff, providing guidance to LPN team members.

Requirements:

• Active, unrestricted RN license and Associate's degree in nursing.
• 2 years of clinical experience plus 2 years in utilization or medical review.
• Working knowledge of criteria, managed care, and Microsoft Office.

Compensation & Benefits:

• Max salary of $65,000 per year with comprehensive benefits.
• 401(k) with company match, PTO, health, vision, and dental insurance.
• Company provided life insurance and short/long term disability.