Clinical Claims Reviewer/ RN

What you’d do

An RN performs utilization management, reviewing claims before and after payment and handling authorization reviews for inpatient, outpatient, concurrent and retrospective cases. The full-time remote role also answers provider post-payment inquiries and applies health plan, MCG, DMAS and CMS criteria. Found on the employer's careers page on Oct 18, 2026. Apply through the link.

You’ll need

• RN license
• 3 years acute care clinical experience
• Utilization management or claims review skills
• Knowledge of MCG, CMS and DMAS criteria
• Health plan experience preferred