Job Summary

A company is looking for a Clinical Denials and Appeals Registered Nurse.

Key Responsibilities:

• Conduct comprehensive Denial Root-cause analysis
• Perform retrospective Medical Record reviews to ensure documentation supports medical necessity
• Coordinate pre-service authorization approvals and construct warranted appeals

Required Qualifications:

• Current Registered Nursing License
• Minimum of 5 years clinical experience
• Clinical Denials Experience required
• Familiarity with medical records assembly and clinical terminology
• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service