Kansas Licensed Nurse Consultant

Job Summary

To support the health and well-being of Kansans, the full-time Kansas Licensed Nurse Consultant will manage the review and processing of predeterminations, claims, and appeals, utilizing independent decision-making in accordance with medical policy and standards, while working remotely, hybrid, or onsite.

Key responsibilities

• Independently resolve predeterminations, claims, and appeals using medical policy and Interqual criteria
• Respond to inquiries regarding medical necessity, correct coding, and audits while providing clinical support to internal staff
• Identify potential quality of care issues and assist with quality assurance and utilization management data analysis

Required qualifications

• Current unrestricted Kansas RN licensure is required
• Minimum of 3 years of clinical nursing experience is required
• Bachelor's degree or equivalent in nursing is preferred
• CPC certification or the ability to obtain it within three years of hire is required
• RN experience in Surgical, Medical, Obstetric, and/or Utilization Management is preferred