Medicaid Clinical Reviewer - RN
Company: VirtualVocations
Location: Naperville
Posted on: October 23, 2024
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Job Description:
A company is looking for a Medical Reviewer III - Managed Care
Project (MCP).
Key Responsibilities
Conduct clinical reviews of medical records for Medicaid claims
Utilize Medicaid guidelines to determine payment coverage
appropriateness
Compile written Investigative Summary Reports in collaboration with
investigators
Required Qualifications and Education
Active Registered Nurse (RN) license from an accredited nursing
school
At least 4 years of experience in utilization/quality assurance
review and coding
Advanced knowledge of ICD-10-CM, CPT coding, and Medicaid coverage
guidelines
Experience with Diagnosis Related Groups (DRGs) and Medicaid claims
processing
Knowledge of NCPDP and prescription drug claims
Keywords: VirtualVocations, Elgin , Medicaid Clinical Reviewer - RN, Healthcare , Naperville, Illinois
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