10/23/2025
The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.
This is a remote role.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager
Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans
Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time...
CorVel
Syracuse, NY, USA
Full Time
