Clinical Appeals RN - Oklahoma Licensed

Job Summary

A company is looking for a Clinical Appeals RN to provide expertise in clinical appeals and grievances while working remotely.

Key Responsibilities:

• Review medical records and verify service criteria
• Evaluate post-service claims for clinical eligibility based on Plan benefits
• Document determinations accurately and adhere to confidentiality regulations

Required Qualifications:

• Active, unrestricted RN license in state of residence
• 3+ years of clinical experience as an RN in an acute, inpatient hospital setting
• Experience in Utilization Management, pre-authorization, claim review, or medical record review
• Solid computer skills, including proficiency in Microsoft Office
• Designated HIPAA compliant home workspace with secure high-speed internet access