North Carolina Licensed Medical Review Analyst - Salinas California

Company: VirtualVocations
Location: Salinas, California
Posted On: 02/02/2025

A company is looking for a Medical Review Analyst who will analyze and determine medical necessity and reimbursement allowances for complex claims.



Key Responsibilities

Determine medical necessity and benefit eligibility for complex claims using clinical expertise and various software systems
Ensure compliance with regulatory requirements and document system issues, recommending solutions
Communicate with members and providers to gather information and document clinical decision-making processes


Required Qualifications

RN, PA, or NP with a minimum of 3 years of clinical experience in various settings, or LPN with 5 years of clinical nursing experience
Must hold and maintain a valid North Carolina clinical license More...

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