Licensed Medical Review Nurse

Performing skilled nursing facility medical claims audits, the remote Medical Review Nurse II - SNF/MDS Auditor will review claims for appropriateness, document findings, and support the appeals process while collaborating with a multi-location audit team. Key responsibilities: Auditing claims for medically appropriate services in skilled nursing facilities using relevant guidelines Documenting audit findings and generating letters to articulate results Collaborating with the audit team to improve medical policies and minimize appeals Required qualifications: Active unrestricted RN license in good standing A minimum of five years of diversified nursing experience in inpatient or outpatient settings At least one year of experience with the MDS/RAI process One year of experience in medical records review Expertise in ICD-9/ICD-10 coding guidelines related to the MDS RAI process