Remote Medical Review Nurse | WFH

Job Overview

We are seeking a dedicated and detail-oriented Medical Review Nurse (MRN) to join our esteemed team in a fully remote capacity. In this pivotal role, you will leverage your clinical expertise to conduct comprehensive assessments of medical records and ensure compliance with national and local policies relating to medical claims and reviews. Your contributions will be vital in upholding the integrity of healthcare services.

Key Responsibilities

• Conduct thorough reviews of complex medical records, billing cases, and claims projects to guarantee accuracy.
• Assess coding practices and apply relevant clinical guidelines alongside medical coverage criteria.
• Collaborate effectively with various stakeholders, including healthcare providers, to facilitate case reviews and informed decision-making.
• Draft detailed inquiry letters, investigation outcomes, and case summaries for accurate record-keeping.
• Investigate potential fraud cases and refer them to the appropriate resources as necessary.
• Enter, track, and report case-specific data as required to support operational goals.
• Perform additional duties as assigned to further the objectives of the program.
  
  

Required Skills

• Active and unrestricted Registered Nurse (RN) License.
• Strong analytical and research skills, with exceptional attention to detail.
• Excellent verbal and written communication abilities.
• Proficiency in Microsoft Word, Excel, and PowerPoint.
• Comfortable navigating multiple research and processing systems.
  
  

Qualifications

• 3-5 years of experience in medical review, claims review, or coding review (CERT experience is a plus).
• Familiarity with inpatient services and associated care.
• Proven experience with Medicare Part A and B claims review, prior authorization, or appeals.
  
  

Career Growth Opportunities

This role provides ample opportunities for professional development and skill enhancement within the healthcare review sector. As part of our team, you will be positioned to advance your career in a dynamic environment focused on accuracy and compliance in medical review operations.

Compensation And Benefits

• Job Type: Full-Time
• Salary: Negotiable
• Location: 100% Remote
• Work Authorization: U.S. (Required)
• Background Check: Required
• Drug Screening: Required
  
  

Join us in making a meaningful impact on healthcare integrity and compliance while enjoying the flexibility of a remote working environment.

Employment Type: Full-Time