Position Description: Medical Review Nurse. Reporting to the Medical Review Manager (MRM), the Medical Review Nurse will provide professional assessment, planning, coordination, and implementation and reporting of complex clinical data to support the Medical Review Accuracy Contract for Provider Resources, Inc (PRI). The Medical Review Nurse will perform comprehensive medical record and claim reviews to make payment determinations based on applic...
100% Remote, Work-From-Home position anywhere in the US. (Any state RN license is accepted). As an RN, you will provide direction, guidance, and support to our physician Medical Claims Reviewers as well as other staff as indicated. Complete quality audits of individual case reviews. Support the clinical aspects of the review process and case reviews, including but not limited to. Support the reviewer selection and assignment process. Resolve oper...
100% Remote, Work-From-Home position anywhere in the US. (Any state RN license is accepted). As an RN, you will provide direction, guidance, and support to our physician Medical Claims Reviewers as well as other staff as indicated. Complete quality audits of individual case reviews. Support the clinical aspects of the review process and case reviews, including but not limited to. Support the reviewer selection and assignment process. Resolve oper...
100% Remote, Work-From-Home position anywhere in the US. (Any state RN license is accepted). As an RN, you will provide direction, guidance, and support to our physician Medical Claims Reviewers as well as other staff as indicated. Complete quality audits of individual case reviews. Support the clinical aspects of the review process and case reviews, including but not limited to. Support the reviewer selection and assignment process. Resolve oper...
100% Remote, Work-From-Home position anywhere in the US. (Any state RN license is accepted). As an RN, you will provide direction, guidance, and support to our physician Medical Claims Reviewers as well as other staff as indicated. Complete quality audits of individual case reviews. Support the clinical aspects of the review process and case reviews, including but not limited to. Support the reviewer selection and assignment process. Resolve oper...
100% Remote, Work-From-Home position anywhere in the US. (Any state RN license is accepted). As an RN, you will provide direction, guidance, and support to our physician Medical Claims Reviewers as well as other staff as indicated. Complete quality audits of individual case reviews. Support the clinical aspects of the review process and case reviews, including but not limited to. Support the reviewer selection and assignment process. Resolve oper...
100% Remote, Work-From-Home position. 2 licenses required, a license within the compact and a license in a state out of the compact. Registered nurse will be auditing medical claim reviews that physicians have completed. Previous medical records review or medical claims review experience is preferred. 1 Skill needed – Critical Thinking capability. Extremely high capability for learning and retaining information. Extremely high level of orientatio...
