Clinical Appeals Coordinator RN
Job Summary
A company is looking for a Clinical Appeals Coordinator RN to join their medical management team.
Key Responsibilities
- Conduct investigations and reviews for member and provider medical necessity appeals
- Review medical records for denied services and provide summaries for the medical director
- Ensure compliance with appeal timeframes and document case information
Required Qualifications
- Bachelor of Science in Nursing from an accredited program
- Active and non-restricted nursing license in West Virginia or a compact license
- Five years of clinical experience, with two years in case management or utilization review
- Medical management experience preferred
COMPLETE JOB DESCRIPTION
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