The right talent can transform your business—and we make that happen. At Collabera, we go beyond staffing to deliver strategic workforce solutions that drive growth, innovation, and agility. With deep industry expertise, a global talent network, and a people-first approach, we connect you with professionals who don’t just fit the role but elevate your business. Partner with us and build a workforce that powers success.
Medical Claim Review Nurse (REMOTE)
Remote: Irving, Texas, US
Salary Range: 40.00 - 41.00 | Per Hour
Job Code: 362861
End Date: 2025-07-12
Days Left: 24 days, 13 hours left
PAY RANGE: $40-$41/hr
- Review past and denied medical claims to check if care was medically necessary and properly billed.
- Use clinical guidelines (like InterQual/MCG), Medicaid/Medicare rules, and policies to make fair decisions.
- Help with audits, appeal reviews, and complex cases like DRG validation and readmissions.
- Work closely with doctors and support teams, document findings, and provide training.
- Also identify quality issues and refer special-needs members to the right programs.
Qualifications:
- RN license (active and in good standing).
- 3+ years of nursing experience.
- 1+ year in Utilization Review or Claims Review.
- 2+ years in Claims Auditing, Coding, or Medical Necessity Review.
- Knowledge of federal/state rules, billing codes (CPT/HCPCS), and guidelines like MCG/InterQual.
Job Requirement
- RN
- Nursing
- Utilization Review
- Claims Review
- Claims Auditing
- Medical Coding
- CPT/HCPCS
- MCG/InterQual
Reach Out to a Recruiter
- Recruiter
- Phone
- Prerana Pandey
- prerana.pandey@collabera.com
Apply Now
Apply Now
