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Remote RN Medical Reviewer & Claims Utilization

your Jared

Brooklyn, NY
  • Remote job

Palmetto GBA is seeking an experienced RN for remote utilization review to evaluate medical claims using established criteria and guidelines. The role emphasizes timely decisions, documentation, and collaboration with internal teams. You will work from a home office and engage in ongoing education with staff regarding coverage determinations. The position requires active RN licensure and 2+ years of clinical experience, with strong communication and analytical skills. #J-18808-Ljbffr your Jared

Vacancy posted 2 days ago
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