State Licensed Clinical Review Nurse
Company: VirtualVocations
Location: Vista
Posted on: May 21, 2025
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Job Description:
A company is looking for a Clinical Review Nurse.
Key Responsibilities
Conduct clinical review and audit of complex medical bills to
ensure medical necessity and compliance with guidelines
Communicate with medical providers and assist management in
identifying opportunities based on billing environments
Oversee specialized pharmacy review initiatives and negotiate high
dollar bills not subject to fee schedule reductions
Required Qualifications
Active and unencumbered professional nursing license (RN preferred
or LPN/LVN with experience)
Three or more years of bill audit experience, including knowledge
of workers' compensation laws and fee schedules
Minimum of three years' clinical experience in operating room,
orthopedics, ER, or similar fields
Certification as a Medical Coder is required
Experience with ICD-9, ICD-10, and CPT coding procedures
Keywords: VirtualVocations, Aliso Viejo , State Licensed Clinical Review Nurse, Healthcare , Vista, California
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