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WS
Winston Staffing
Utilization Review Nurse
Career Insights for Medical Claims Examiner
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What they do
A Medical Claims Examiner evaluates medical insurance claims in accordance with applicable contracts and government regulations. Verifies that medical treatment costs are accurate given a patient's diagnosis. May specialize in specific types of treatments or types of drug claims.
$51,920 / year median in the U.S.
+4% projected growth
Job Description
Utilization Review Nurse at Winston Staffing Utilization Review Nurse at Winston Staffing in Hillside, New Jersey Posted in 2 days ago.
Type:
full-timeJob Description:
100% remote but would need to go to Newark, NJ first day to pick up equipment and orientation Review insurance claims- Analyze medical records and documentation
- Compare cases with clinical guidelines and insurance policies
- Write appeal recommendations or determinations
- Work with providers, insurance companies, and case managers
- Ensure decisions follow regulatory and medical necessity standards