California Licensed Clinical Appeals RN

Job Summary

A company is looking for a Clinical Appeals RN, Remote in EST or CST Time Zone.

Key Responsibilities

• Perform initial assessment review of appeals, medical records, and CMS/State Policies to determine coverage and billable criteria
• Identify additional information required to process appeals and adapt to changes in appeal types
• Utilize clinical nursing judgment and critical thinking to make decisions on administrative nurse level cases

Required Qualifications

• Current, valid, and unrestricted RN licensure in the state of residence
• 2+ years of clinical experience in an acute care or outpatient setting
• 1+ years of experience in Utilization Review or Medicaid/Medicare appeals
• Understanding of billable services and claims in a managed care environment
• Access to high-speed internet and ability to work 8-5 within the EST time zone