Arizona Licensed RN Clinical Appeals Nurse

Job Summary

A company is looking for an RN Clinical Appeals Nurse Remote.

Key Responsibilities

• Perform clinical/medical reviews of denied cases and reevaluate medical claims and records
• Apply appropriate criteria to assess service appropriateness, length of stay, and level of care
• Serve as a clinical resource and provide training and mentoring for less experienced team members

Required Qualifications

• At least 3 years of clinical nursing experience, with 1 year in managed care or relevant programs
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Knowledge of ICD-9, CPT coding, and HCPC
• Familiarity with CMS guidelines, MCG, InterQual, and state regulatory requirements
• Experience in claims auditing or recovery auditing is preferred