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Nebraska Licensed Medical Review Specialist
A company is looking for a Medical Review Specialist to perform medical reviews and ensure compliance with regulations and policies. Key Responsibilities Conduct accurate and timely medical reviews of claims and preauthorizations Ensure compliance with State and Federal regulations and company mandates Collaborate with healthcare providers and internal teams to promote effective care and resource use Required Qualifications Associate degree in nursing or Certified Practical Nurse with three years of clinical experience Current, unrestricted Registered Nurse or Licensed Practical Nurse license from Nebraska or participating consortium state Bachelor's degree in a healthcare field (preferred) Certification in Managed Care (preferred) Experience in medical review or utilization management (preferred)
A company is looking for a Medical Review Specialist to perform medical reviews and ensure compliance with regulations and policies.
Key Responsibilities
Conduct accurate and timely medical reviews of claims and preauthorizations
Ensure compliance with State and Federal regulations and company mandates
Collaborate with healthcare providers and internal teams to promote effective care and resource use
Required Qualifications
Associate degree in nursing or Certified Practical Nurse with three years of clinical experience
Current, unrestricted Registered Nurse or Licensed Practical Nurse license from Nebraska or participating consortium state
Bachelor's degree in a healthcare field (preferred)
Certification in Managed Care (preferred)
Experience in medical review or utilization management (preferred)