Illinois and Wisconsin RN Claim Reviewer

A company is looking for a Medical Claim Review Nurse (RN) to perform clinical reviews of medical claims and appeals. Key Responsibilities Conducts clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing Identifies quality of care issues and assists with complex claim reviews Documents findings and provides clinical support for Utilization Management and appeals processes Required Qualifications Graduate from an Accredited School of Nursing Minimum 3 years of clinical nursing experience Minimum 1 year of experience in Utilization Review and/or Medical Claims Review Active, unrestricted State Registered Nursing (RN) license in good standing Familiarity with state/federal regulations

Jun 22, 2025 - 09:10

A company is looking for a Medical Claim Review Nurse (RN) to perform clinical reviews of medical claims and appeals. Key Responsibilities Conducts clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing Identifies quality of care issues and assists with complex claim reviews Documents findings and provides clinical support for Utilization Management and appeals processes Required Qualifications Graduate from an Accredited School of Nursing Minimum 3 years of clinical nursing experience Minimum 1 year of experience in Utilization Review and/or Medical Claims Review Active, unrestricted State Registered Nursing (RN) license in good standing Familiarity with state/federal regulations