North Carolina Licensed Medical Review Analyst
Company: VirtualVocations
Location: Salinas
Posted on: February 1, 2025
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Job Description:
A company is looking for a Medical Review Analyst who will
analyze and determine medical necessity and reimbursement
allowances for complex claims.
Key Responsibilities
Determine medical necessity and benefit eligibility for complex
claims using clinical expertise and various software systems
Ensure compliance with regulatory requirements and document system
issues, recommending solutions
Communicate with members and providers to gather information and
document clinical decision-making processes
Required Qualifications
RN, PA, or NP with a minimum of 3 years of clinical experience in
various settings, or LPN with 5 years of clinical nursing
experience
Must hold and maintain a valid North Carolina clinical license
Keywords: VirtualVocations, Cupertino , North Carolina Licensed Medical Review Analyst, Professions , Salinas, California
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