Medical Drug Management Nurse - Fairfax Virginia

Company: VirtualVocations
Location: Fairfax, Virginia
Posted On: 11/20/2024

A company is looking for a Medical Drug Management Nurse Reviewer.



Key Responsibilities

Determine the appropriateness of services and manage reviews of cases, including appeals
Evaluate and direct members to appropriate healthcare services and ensure continuity of care
Provide educational assistance to providers regarding covered and non-covered care


Required Qualifications, Training, and Education

Graduate of a registered nursing program approved by the Ohio State Nursing Board
3 years of experience as a Registered Nurse with clinical and utilization/case management experience
Current unrestricted Registered Nurse license in the State of Ohio
Knowledge of medical/pharmacy terminology and managed care processes
Strong knowledge of clinical claim management including ICD 10, CPT, and HCPCS codes More...

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