Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse (PRN).

Responsibilities

• Prepare clinical appeals in response to medical necessity denials and DRG reassignments
• Utilize industry guidelines and Medicare policies for reviewing medical records and writing appeals
• Participate in Administrative Law Judge Hearings to reverse Medicare denials

Qualifications

• Bachelor of Science degree in Nursing
• Current state RN licensure
• 5 years of clinical experience in an acute care setting
• 3 years of case management, concurrent review, or utilization management experience
• Proficiency in medical record review