Licensed Appeals Nurse

Job Summary

A company is looking for an Appeals Nurse to join their team.

Key Responsibilities:

• Communicates with medical office personnel to gather clinical information and documents rationale for approvals and denials
• Interfaces with various departments to resolve issues related to appeals and retrospective reviews
• Tracks post-determination cases to completion and ensures compliance with health plan policies

Required Qualifications:

• 1-3 years of experience in clinical Appeals Review or Utilization Management Review as an LPN or RN
• Ability to exercise independent judgment in clinical decision-making
• Strong organizational and time management skills
• Outstanding interpersonal and negotiation skills
• Computer literate and able to navigate internal and external systems