Nurse RN 5

Responsibilities

• Review clinical claims to determine if retrospective claims should be paid according to benefits and/or policy.

Requirements

• RN or LVN licensed in California.
• Minimum 2 years of experience as an RN or LVN.
• Strong clinical judgement.
• Strong computer skills.
• Ability to work independently with minimal supervision.

Preferred Skills

• Detail-oriented.
• Prior work history in Post Service, Prior Authorization, or Concurrent Review.
• Preferential interview consideration for Post Service experience.
• Lives in California.

Disqualifiers

• Incomplete resumes with gaps in time or lack of recent work experience in the role.

Qualifications

Software Skills Required: MS Office Suite apps, JIRA, EMR Systems, or similar.