An independent subsidiary of WellPoint, Inc, National Government Services (NGS) is one of the largest Medicare contractors in the country, serving nearly 200,000 providers and suppliers and over 20 million customers with Medicare in 20 states and five U.S. territories.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
*Position will be able to telecommute after training*
Our Nurse Reviewer I is responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries.
Primary duties may include, but are not limited to:
- Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
Requires an AS/BS in nursing; 1 year of clinical experience with an understanding of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license required. Ability to comprehend medical policy and criteria to clearly articulate health information required.