Medical Reviewer II
Health Care Service Corporation•Helena, MT
•$61,500 - $136,100•Remote
About The Position
This position is responsible for performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical necessity, contract interpretation, and pricing; and to initiate and/or respond to correspondence from providers or members concerning medical determinations.
Requirements
- Registered Nurse with current, active, unrestricted Registered Nurse (RN) license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
- 3 years clinical experience.
- Verbal and written communications skills.
- Analytical and decision-making skills.
- Customer Service skills.
Nice To Haves
- Prior MRU experience
- NICU experience
Responsibilities
- Performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical necessity, contract interpretation, and pricing.
- Initiating and/or responding to correspondence from providers or members concerning medical determinations.
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
