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Remote Medicaid Clinical Review RN

Spectraforce Technologies

Raleigh, NC
  • Remote job

  • pSpectraforce Technologies is seeking a Clinical Review Nurse - Concurrent Review for a remote, 9-month assignment. The role involves handling Denial Letters for FL Medicaid Physical Health Codes and requires you to work remote with a Friday–Tuesday schedule, 2 pm–10 pm CST, totaling 40 hours per week.
  • pYou will work within TruCare Classic, meet production targets after training, and collaborate with a team to ensure accurate and timely denial communications.
#J-18808-Ljbffr Spectraforce Technologies

Vacancy posted 2 days ago
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