Ohio Licensed Clinical Review Nurse

A company is looking for a Clinical Appeal & Claim Review Nurse II. Key Responsibilities Independently evaluates medical claims and appeal cases to assess service appropriateness Summarizes medical information for physician review and generates written status updates Acts as a resource for providers and collaborates with internal departments to ensure appropriate member care Required Qualifications Graduate of a registered nursing program approved by the Ohio State Nursing Board; Bachelor's degree preferred 3 years of experience as a Registered Nurse in acute care, critical care, or relevant clinical settings Registered Nurse with a current State of Ohio unrestricted license Familiarity with clinical claim management, medical terminology, and healthcare regulations PC and keyboarding proficiency; Intermediate Microsoft Office skills

May 13, 2025 - 23:36

A company is looking for a Clinical Appeal & Claim Review Nurse II. Key Responsibilities Independently evaluates medical claims and appeal cases to assess service appropriateness Summarizes medical information for physician review and generates written status updates Acts as a resource for providers and collaborates with internal departments to ensure appropriate member care Required Qualifications Graduate of a registered nursing program approved by the Ohio State Nursing Board; Bachelor's degree preferred 3 years of experience as a Registered Nurse in acute care, critical care, or relevant clinical settings Registered Nurse with a current State of Ohio unrestricted license Familiarity with clinical claim management, medical terminology, and healthcare regulations PC and keyboarding proficiency; Intermediate Microsoft Office skills