Clinical Review Nurse Jobs

About The Position

Requirements

• Associate degree in nursing and at least one year of clinical experience, or an equivalent combination of education and experience.
• Current unrestricted RN license.
• Foreign national applicants must have lived in the United States for at least three of the past five years.
• Must be within a reasonable commuting distance of an eligible office, unless an accommodation is granted.

Nice To Haves

• Home Health or Hospice experience is very strongly preferred.
• Knowledge of Medicare guidelines is preferred.
• Bachelor of Science in nursing is preferred.
• Ability to comprehend medical policy and criteria and clearly articulate health information is strongly preferred.

Responsibilities

• Assess the necessity and reasonableness of items supplied in a valid claim using medical policy and other materials.
• Review and adjudicate claims.
• Make medical determinations about whether a claim meets the benefits carried by the member.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical benefits
• Dental benefits
• Vision benefits
• Short-term disability benefits
• Long-term disability benefits
• 401(k) with matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources