Ohio Licensed Clinical Review Nurse

Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025

Job Description:

A company is looking for a Clinical Appeal & Claim Review Nurse II.
Key Responsibilities

Independently evaluates medical claims and appeal cases to assess service appropriateness
Summarizes medical information for physician review and generates written status updates
Acts as a resource for providers and collaborates with internal departments to ensure appropriate member care

Required Qualifications

Graduate of a registered nursing program approved by the Ohio State Nursing Board; Bachelor's degree preferred
3 years of experience as a Registered Nurse in acute care, critical care, or relevant clinical settings
Registered Nurse with a current State of Ohio unrestricted license
Familiarity with clinical claim management, medical terminology, and healthcare regulations
PC and keyboarding proficiency; Intermediate Microsoft Office skills

Keywords: VirtualVocations, Cathedral City , Ohio Licensed Clinical Review Nurse, Healthcare , Vista, California

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