Indiana Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse responsible for processing clinical appeals and attending state hearings.

Key Responsibilities

• Complete clinical appeals and state hearings in compliance with regulatory standards
• Analyze medical records and documentation to make informed decisions on appeals
• Communicate outcomes effectively to members, providers, and state agencies

Required Qualifications, Training, and Education

• Associate's Degree required
• Current, unrestricted license as a Registered Nurse (RN) is required
• Managed care, appeals, Medicare, and Medicaid experience preferred
• Prior clinical appeals or Utilization review experience is strongly preferred
• MCG Certification is required or must be obtained within six months of hire