Clinical Appeals Registered Nurse

Job Summary

A company is looking for a Clinical Denials and Appeals RN.

Key Responsibilities

• Conduct medical necessity reviews and retrospective medical record reviews
• Prepare and track clinical appeals while collaborating with various teams to resolve denials
• Research payer policies and track denial and appeal outcomes for process improvement

Required Qualifications, Training, and Education

• Current and unrestricted Registered Nurse license in the state of residence
• University Degree with 4-6 years of relevant acute care clinical experience
• Prior experience in clinical denials, utilization review, case management, or appeals
• Experience with InterQual and/or Milliman Care Guidelines and electronic medical record systems
• Bachelor's or Master's degree in Nursing preferred