Medical Claims Review Nurse Ii

Job summary
Medical Claims Review Nurse IILocation: Remote in Washington StateEmployer: HMA
Job seniority: mid-to-senior level
Responsibilities
• Monitor member utilization and claim patterns• Utilize clinical nursing knowledge and coding expertise to oversee claim accuracy• Provide clinical expertise to the Appeals team• Generate written correspondence to providers, members, brokers, and clients
Requirements
• Current Baccalaureate prepared (Preferred)• Active RN clinical license• Current Certified Professional Coder certificate (preferred)• 3-5+ years of clinical nursing experience• Knowledge of Utilization Review processes• Knowledge of the medical plan appeal process (preferred)• Strong experience in clinical practice with diverse diagnoses• Problem solving and critical thinking skills• Excellent verbal and written communication skills• Proficiency with Microsoft Office applications• Ability to be self-motivated and self-directed• Behavioral health experience (Preferred)
Key Skills Needed
• Clinical nursing knowledge• Coding expertise• Written communication skills• Problem solving skills• Critical thinking skills
Benefits
• Comprehensive salary• Pay transparency• Benefits package• Personal development and growth opportunities• Meaningful work• Work/life balance• Contribution to something important