Florida Licensed Clinical Appeals Nurse

Job Summary

A company is looking for an RN Clinical Appeals Nurse Remote.

Key Responsibilities

• Perform clinical reviews of previously denied cases and reevaluate medical claims
• Apply appropriate criteria and resolve escalated complaints regarding utilization management
• Serve as a clinical resource and provide training for less experienced appeals nurses

Required Qualifications

• At least 3 years of clinical nursing experience, with 1 year in managed care
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Knowledge of ICD-9, CPT coding, and HCPC
• Understanding of CMS guidelines and state regulatory requirements
• Critical-thinking skills and ability to interact effectively with clinical leaders