RN Medical Reviewer — Claims & Coverage Expert

Job description

Blue Cross & Blue Shield of Mississippi is seeking an RN Medical Reviewer for the Federal Employee Program (FEP) to conduct thorough clinical reviews of pre-service requests and post-service claims for medical and medical drug services.

The role requires a Mississippi RN license, a Bachelor’s degree in Nursing (Master’s preferred), at least two years of clinical experience, and strong analytical, decision-making, and documentation skills to determine coverage and medical necessity.

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Who can apply

Review the original listing for work authorization, qualifications and employer requirements.