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Remote Nurse Reviewer - Medical Claims & Policy Reviews

Healthcare Quality Strategies, Inc. (HQSI)

Florida, NY
  • Remote job

A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining claims, maintaining knowledge of Medicaid policies, and managing the screening process effectively. Candidates must possess a BSN with an active RN license and have 3-5 years of review experience. This position offers a chance to work in a remote setup with competitive hours. Benefits include medical, dental, and 401k options. #J-18808-Ljbffr Healthcare Quality Strategies, Inc. (HQSI)

Vacancy posted 4 days ago
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