California Licensed Clinical Claims Nurse

A company is looking for a Medical Claim Review Nurse. Key Responsibilities Review medical records and claims for medical necessity and coding accuracy Conduct retrospective audits including DRG Validation, Level of Care, and Readmission reviews Collaborate with Medical Directors and assist Utilization Management teams Required Qualifications Active, unrestricted RN license 3+ years of clinical nursing experience Experience with medical claims review, auditing, or utilization management preferred Familiarity with MCG/InterQual or willingness to train

Jun 12, 2025 - 07:30

A company is looking for a Medical Claim Review Nurse. Key Responsibilities Review medical records and claims for medical necessity and coding accuracy Conduct retrospective audits including DRG Validation, Level of Care, and Readmission reviews Collaborate with Medical Directors and assist Utilization Management teams Required Qualifications Active, unrestricted RN license 3+ years of clinical nursing experience Experience with medical claims review, auditing, or utilization management preferred Familiarity with MCG/InterQual or willingness to train