Illinois and Wisconsin RN Medical Claim Reviewer

Company: VirtualVocations
Location: Vista
Posted on: May 13, 2025

Job Description:

A company is looking for a Medical Claim Review Nurse (RN) Remote IL & WI.
Key Responsibilities

Conducts clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing
Identifies quality of care issues and assists with complex claim reviews
Documents findings and provides clinical support for denial or modification of payment decisions

Required Qualifications

Graduate from an Accredited School of Nursing
Minimum 3 years of clinical nursing experience
Minimum 1 year of experience in Utilization Review and/or Medical Claims Review
Active, unrestricted State Registered Nursing (RN) license in good standing
Familiarity with state/federal regulations

Keywords: VirtualVocations, Florence-Graham , Illinois and Wisconsin RN Medical Claim Reviewer, Healthcare , Vista, California

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