Executives-Clinicians-Nurses-USRN

Provide world‑class customer service for every case, evaluating medical records for procedures, inpatient stays, surgical and benefit cases to determine appropriateness of health care and services. Ensure care meets or exceeds medically accepted standards, assess records for medical history and symptoms to approve cases or forward to higher‑level review, and focus on delivering a great customer experience.

Responsibilities

• Provide world‑class service to customers in an accurate, efficient, and courteous manner on every case, based on the documents sent for review using medical records for procedures, inpatient stays, surgical cases, and benefit cases.
• Evaluate the appropriateness of health care and services provided to patients covered under the plan, ensuring quality meets or exceeds medically accepted standards.
• Assess records for medical history and symptoms to use as data in approving the case or sending to a higher‑level reviewer. ...