Nurse Reviewer - Allentown, PA
$83,200–$83,200 year
On-site · Allentown, Pennsylvania, United States
Allentown, Pennsylvania, United StatesOn-sitePart Time$83,200–$83,200 yearMid LevelBachelors DegreeUnknown
Type
Part Time
Level
Mid Level
Education
Bachelors Degree
Company size
Unknown
Job Summary
Nurse Reviewer in Allentown, PA (part-time remote) provides comprehensive medical necessity and Medicaid policy reviews, conducts medical record reviews, documents evidence-based criteria, and reports screening results. The role requires expertise in ICD-10, CPT, HCPCS coding, InterQual/MCG criteria, HIPAA/HITECH compliance, and strong written/verbal communication, with collaboration to ensure timely productivity and quality for the Medical Review Services team.
Required Qualifications
- BSN with active RN licensure in good standing
Desired Qualifications
- BSN with active RN licensure in good standing
- 3-5 years medical record review experience
- Proficiency with Microsoft Office (Word, Excel, and Outlook)
- Knowledge of ICD-10, CPT, and HCPCS
- InterQual and MCG criteria knowledge
- HIPAA/HITECH compliance
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