Medical Reivew Analyst-RN/LPN


Medical and Nursing

Advert ID



Winston Salem

Job Type




Salary Range

No. of Openings


Branch Information

Raleigh - Durham NC Area - (USA) 430 Davis Drive Suite 100 NC Morrisville , NC - 27560 Phone : 855-591-7454



Job Description

Calling all RNs and LPNs!! Looking to make a change in your career? Tired of the long shifts? Feet hurting? Want to find a way to work a consistent schedule but still make a positive impact on peoples lives?

Medical Review Analyst:

Determines pre- existing, medical necessity, benefit eligibility and/or appropriate reimbursement allowances for complex claims and/or products by using clinical experience, medical literature, medical records, certificate guidelines, medical policy and several complex and varied computer application software systems.

Ensures that review and determinations meet all requirements per line of business by Regulatory and Accrediting bodies

Identifies, documents, and escalates system and process problems. Through analysis, determines root cause and recommends possible solutions. Defines, communicates and follows up as appropriate on the root causes of errors to others.

Reviews physician-submitted and member-submitted claims for specified services, utilizing professional knowledge and developed criteria, to determine the medical necessity of the treatment. Refers cases that do not meet criteria to the Medical Director with appropriate clinical analysis and summaries. Issues denials according to department protocols. Documents outcome of reviews.

Hiring preferences:

- RN license with 3+ years of hands on patient care experience

- LPN license with 5+ years of hands on patient care experience

- Computer proficiency and familiarity with the Microsoft suite

- Experience working in a hospital or in a large health-care facility is preferred

Don't wait- apply today!