Medical Review Nurse -UM/Post Appeals (Michigan RN license req)

Job Description Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers. Job Duties - Facilitates medical review of prospective, retrospective, and concurrent review of appeal…