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Medical Review Nurse

Company: Health Net, Inc.
Location: Fresno
Posted on: December 4, 2019

Job Description:

Description: Position Purpose: Perform retrospective review of large hospital and physician claims for admission appropriateness, coding, length of stay, and pricing and review retrospective medical necessity appeals against medical review criteria to make benefit determinations. * Perform retrospective high dollar claims for benefit and pricing-determination. * Collect hospital medical records as appropriate and work with related hospital staff. * Work collaboratively with Finance Department to determine appropriateness of pricing. * Assist with other clinical functions of medical review. * Maintain appropriate records, files, documentation, etc.

Keywords: Health Net, Inc., Fresno , Medical Review Nurse, Healthcare , Fresno, California

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