RN-Medical Review Analyst

Industry

Medical and Nursing

Advert ID

USA_476319

Location

Durham

Job Type

Contract

Hours

Full-Time

Salary Range

Based on Experience

No. of Openings

1

Branch Information

Raleigh - Durham NC Area - (USA) 430 Davis Drive Suite 100 NC Morrisville , NC 27560

Branch Phone Number

855-591-7454

Job Description

Calling all RNs and LPNs!! Looking to make a change in your career? Tired of the long shifts? Feet hurting? Want to find a way to work a consistent schedule but still make a positive impact on people's lives? We've got the job for you in Durham!!



The Medical Review Analyst is responsible for:



* Determines pre- existing, medical necessity, benefit eligibility and/or appropriate reimbursement allowances for complex claims and/or products by using clinical experience, medical literature, medical records, certificate guidelines, medical policy and several complex and varied computer application software systems.

* Ensures that review and determinations meet all requirements per line of business by Regulatory and Accrediting bodies

* Communicates with members and providers to obtain additional information. Informs members, providers, and internal customers of claims status and determinations



Hiring preferences:

- RN license with 3+ years of hands on patient care experience

- LPN license with 5+ years of hands on patient care experience

- Computer proficiency and familiarity with the Microsoft suite

- Experience working in a hospital or in a large health care facility is preferred



This would be a Monday-Friday 8am-5pm role!!



If this sounds like you, don't wait- apply today!