At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience.
Registered Nurse (RN).
License must be active and unrestricted in state of practice.
Compact license is acceptable where states allow.
Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and
Healthcare Common Procedure Coding (HCPC).
Experience working within applicable state, federal, and third-party regulations.
Common look proficiency.
Microsoft Office suite and applicable software program(s) proficiency.
