Nurse Reviewer

Santa Barbara Cottage Hospital; Canada; Remote; CAD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider is seeking a Nurse Reviewer responsible for evaluating medical claims to ensure compliance with regulations. Candidates should possess a bachelor's degree in nursing and have relevant experience, alongside effective communication and analytical skills. This role provides the opportunity to work in a collaborative environment to support healthcare quality.

Qualifications

• Bachelor's degree in nursing or a related field.
• 3-5 years of experience in medical claims review or related role.
• Strong communication, confidentiality, and analytical skills.

Responsibilities

• Review medical claims ensuring compliance with company policies.
• Conduct management reporting and maintain source documents.
• Communicate effectively with clients and team members.

Skills

Communication

Confidentiality

Legal Practices

Management Reporting

Written Communication

Education

Bachelor's degree in nursing or a related field

Job description

It's fun to work at a company where people truly believe in what theyare doing!

Job Description:

Job Summary

The Nurse Reviewer is responsible for reviewing medical claims, ensuring compliance with company policies and legal practices. This role requires strong communication, confidentiality, and analytical skills.

Essential Job Responsibilities

• Review medical claims and ensure compliance with company policies and legal practices.

• Conduct management reporting and maintain source documents.

• Communicate effectively with clients and team members.

• Maintain professional etiquette and organizational abilities.

Qualifications & Requirements

Education:

• Bachelor's degree in nursing or a related field.

Experience:

• 3-5 years of experience in medical claims review or a related role.

Skills:

• Communication

• Company Policies

• Confidentiality

• Languages

• Legal Practices

• Management Reporting

• Source Documents

• Standard Operating Procedure (SOP)

• Supervision

• Written Communication

Certifications:

• Required: None

• Preferred: Registered Nurse (RN) License, Certified Professional in Healthcare Quality (CPHQ), Legal Nurse Consultant Certified (LNCC)

Physical Requirements:

• Ability to work in an office environment and perform tasks that may require sitting, standing, and using office equipment.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

It is Epiq’s policy to comply with all applicable equal employment opportunity laws by making all employment decisions without unlawful regard or consideration of any individual’s race, religion, ethnicity, color, sex, sexual orientation, gender identity or expressions, transgender status, sexual and other reproductive health decisions, marital status, age, national origin, genetic information, ancestry, citizenship, physical or mental disability, veteran or family status or any other basis protected by applicable national, federal, state, provincial or local law. Epiq’s policy prohibits unlawful discrimination based on any of these impermissible bases, as well as any bases or grounds protected by applicable law in each jurisdiction. In addition Epiq will take affirmative action for minorities, women, covered veterans and individuals with disabilities. If you need assistance or an accommodation during the application process because of a disability, it is available upon request. Epiq is pleased to provide such assistance and no applicant will be penalized as a result of such a request. Pursuant to relevant law, where applicable, Epiq will consider for employment qualified applicants with arrest and conviction records.