Nurse Reviewer - Orlando, FL
$83,200–$83,200 year
Remote · Orlando, Florida, United States
Orlando, Florida, United StatesRemoteContract$83,200–$83,200 yearMid LevelBachelors DegreeUnknown
Type
Contract
Level
Mid Level
Education
Bachelors Degree
Company size
Unknown
Job Summary
Nurse Reviewer performs comprehensive medical necessity and policy reviews for Medicaid claims, documents evidence-based criteria, and reports screening results. The role requires review of medical records using ICD-10, CPT, and HCPCS codes, adherence to HIPAA/HITECH, and collaboration with the Team Lead and Physician Peer Reviewer. Remote, part-time (20-30 hours/week), non-exempt, with focus on timely, accurate medical record reviews and adherence to contract-specific criteria.
Required Qualifications
- BSN with active RN licensure in good standing
- 3-5 years performing medical record review and/or abstraction
- Experience performing medical record review, audit for federal or state contracts
- Knowledge of Medicare and Medicaid policy
- Proficiency with Microsoft Office (Word, Excel, and Outlook)
- Proficiency with Adobe PDF files and features
- Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
- Strong written and verbal communication
- Ability to work independently and as part of a team
- Ability to manage time and meet deadlines
- Knowledge of ICD-10, CPT, HCPCS
- HIPAA/HITECH compliance
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