Clinical Appeals RN
Location: Remote
Compensation: Hourly
Staff Reviewed: Wed, Nov 27, 2024
This job expires in: 24 days
Job Summary
A company is looking for a Clinical Appeals RN (Remote) to support their health insurance operations.
Key Responsibilities
- Investigates and analyzes written appeals and reconsideration requests from various sources
- Organizes appeal cases for physician review and communicates final decisions to members and providers
- Utilizes nursing expertise to assess the appropriateness of adverse coverage decisions
Required Qualifications, Training, and Education
- Must hold an RN license
- 2 years of experience in Medical Review, Utilization Management, or Case Management
- BSN or MSN degree is required
- Knowledge of regulatory and accreditation requirements related to the appeals process
- Proficiency in Microsoft Office programs
COMPLETE JOB DESCRIPTION
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