Medical Review Nurse Jobs Necnic Group - Sacramento, CA - Sacramento, CA - Medical Review Nurse (CA Health & Wellness) P...

Medical Review Nurse Jobs Necnic Group - Sacramento, CA - Sacramento, CA - Medical Review Nurse (CA Health & Wellness) P...
Apply to jobs now hiring in California today!Apply to jobs now hiring in California today! Medical Review Nurse Jobs c07c0deca7cb9bd10f952db4e1677d7e Necnic Group - Sacramento, CA - Sacramento, CA - Medical Review Nurse (CA Health & Wellness) Position Purpose: Perform retrospective review of large hospital and physician claims for admission appropriateness, coding, length of stay, and pricing and review retrospective medical necessity appeals against medical review criteria to make benefit determinations. Perform retrospective high dollar claims for benefit and pricing-determination. Collect hospital medical records as appropriate and work with related hospital staff. Work collaboratively with Finance Department to determine appropriateness of pricing. Assist with other clinical functions of medical review. Maintain appropriate records, files, documentation, etc. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred....

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