Licensed Nurse Consultant

Job Summary

To optimize clinical denials operations, the full-time Licensed Nurse Consultant will coordinate case study presentations, provide onboarding and mentoring for new hires, and participate in the quality assurance process while working remotely.

Key Responsibilities

• Coordinate Clinical Case Study presentations and manage communications at the Nurse Consultant level
• Provide onboarding, training, and mentoring to new nurse hires
• Participate in the quality assurance process to ensure compliance with guidelines and deadlines

Required Qualifications

• Licensed RN with a college degree or diploma from a nursing school
• Minimum 5 years of experience in denials and appeals or hospital revenue cycle
• Clinical nursing experience in a hospital environment, preferably in ER, ICU, Med-Surg, or Transplant unit
• Familiarity with MCG, InterQual, NCD/LCDs, and payor medical policies
• Moderate computer proficiency with Microsoft Office applications