Remote RN Medical Claims Reviewer II

Palmetto GBA, LLC; United States; A distancia; USD 68.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Subsidized health plans

401k retirement plan

Life Insurance

Paid Time Off (PTO)

Education Assistance

Service Recognition

National discounts

Descripción de la vacante

Palmetto GBA, LLC seeks a remote RN reviewer to perform medical claim reviews using clinical information and established guidelines. You will document decisions and support utilization practices from home.

The role requires an RN license, 2+ years of clinical experience, and strong communication and analytical skills. Training is provided, with a 40-hour work week and standard business hours.

Formación

• Associate degree in nursing or equivalent with RN licensure.
• Two years of clinical nursing experience.
• Proficiency in word processing and Microsoft Office.
• Ability to work independently and manage priorities.
• Strong communication, customer service, and analytical skills.
• Discretion handling confidential information.

Responsabilidades

• Review medical claims and determine medical necessity using criteria and guidelines.
• Educate staff on review processes, coding procedures, and coverage determinations.
• Support quality assurance activities and guidance to team members.

Conocimientos

RN licensure

Clinical experience

Word processing

Independent work

Customer service

Communication

Analytical thinking

Discretion

Educación

Associate Degree – Nursing

Graduate of an accredited School of Nursing

Herramientas

Microsoft Office

Descripción del empleo

Palmetto GBA, LLC seeks a remote RN reviewer to perform medical claim reviews using clinical information and established guidelines. You will document decisions and support utilization practices from home.

The role requires an RN license, 2+ years of clinical experience, and strong communication and analytical skills. Training is provided, with a 40-hour work week and standard business hours.