Licensed Nurse Consultant Team Lead

Job Summary

To optimize department operations related to clinical denials, the full-time Licensed Nurse Consultant Team Lead will manage team functions, provide training and mentoring for new hires, and ensure quality assurance processes are met while working remotely.

Key Responsibilities

• Coordinate Clinical Case Study presentations for clients and oversee preparation at the Nurse Consultant level
• Provide onboarding, training, and mentoring for new nurse hires while assisting with workflow management
• Participate in quality assurance processes and support nurses with account-related questions regarding appeals and denial resolutions

Required Qualifications

• Licensed RN with a college degree or diploma from an accredited nursing school
• Minimum of 5 years of experience in denials and appeals or hospital revenue cycle
• Experience with MCG, InterQual, NCD/LCDs, and payor medical policies
• Clinical nursing experience in a hospital setting, preferably in ER, ICU, Med-Surg, or Transplant units
• Moderate computer proficiency, including Microsoft Word, PowerPoint, Excel, and PDF files