Medical Reviewer II

Role Overview

• Perform accurate and timely medical review of claims suspended for medical necessity
• Initiate and/or respond to correspondence from providers or members concerning medical determinations

Requirements

• Registered Nurse with current, active RN license
• 3 years clinical experience
• Verbal and written communications skills
• Analytical and decision-making skills
• Customer Service skills

Benefits

• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement
• Other incentives