Job Description

The ideal candidate for this position will have CPC coding certification and CPT and DRG coding experience.  An Arizona state nursing license is required.


The Medical Claims Review RN / Registered Nurse reviews and analyzes medical record and claims data, utilizing and applying Interqual Acute / Subacute Care Criteria and DRG coding practices to determine if inpatient admissions, observation stays, and ancillary services meet criteria.  This position also maintains current information on regulatory guidelines as they pertain to acute and subacute levels of care.  The RN will also provide direction and periodic consultation to LPNs for any nursing professional practice or complex clinical decision making needs that may arise in the function of the department.


The Medical Claims Review RN reviews medical records and claims data for acute and subacute levels of care.  Collects and screens data for clinical review.  Provides assistance to Utilization Review nurses.



Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



High School Diploma or GED

Associate's or Bachelor's degree from an accredited nursing school

CPT and DRG coding experience

Active, current, valid, unrestricted Arizona State Registered Nursing license

CPC coding certification strongly preferred

At least one (1) year medical claims experience

At least one (1) year experience working in a medical environment such as a hospital, medical office, or health plan

Previous Medicare / Medicaid experience

Interqual Acute / Subacute criteria


Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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