Medical Review Nurse
S C A N(1 month ago)
About this role
A Clinical Claims Review Nurse at SCAN Group performs clinical evaluation of healthcare claims and supports adjudication of post-service appeals for a nonprofit Medicare Advantage plan serving older adults. The role sits within medical management and collaborates with clinical leadership to ensure appropriate benefits administration. This is a remote position requiring an active California RN license.
Required Skills
- Clinical Review
- Medical Claims
- Medical Records
- Clinical Decisioning
- CMS Guidelines
- Claim Auditing
- Utilization Review
- Communication
- Teamwork
- Problem Solving
Qualifications
- Associate's Degree
- California RN License
- Bachelor's Degree (Preferred)
- Certified Professional Coder (Preferred)
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