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Medical Claim Review Nurse Remote with MI RN License
JOB DESCRIPTIONJob SummaryUtilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. We are seeking a Registered Nurse with Appeals or claim review knowledge. Must be computer skilled with the ability to navigate between numerous programs at once. Able to work independently in a high-volume environment meeting metric production. Michigan RN license required.  Further details to be discussed during our


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