Texas Licensed Medical Review Nurse in Omaha, NE

A company is looking for a Medical Review Nurse (RN) to provide support for medical claim and internal appeals review activities. Key Responsibilities Facilitates clinical / medical reviews of retrospective medical claims and appeals to ensure medical necessity and accurate billing Validates member medical records and claims to ensure appropriate reimbursement and resolves escalated complaints regarding utilization management Serves as a clinical resource for utilization management and provides training and support to clinical peers Required Qualifications At least 2 years of clinical nursing experience, including 1 year in utilization review or medical claims review Active and unrestricted Registered Nurse (RN) license in the state of practice Experience with ICD-10, CPT coding, and HCPC coding Knowledge of applicable state and federal regulations Analytic and decision-making skills