Licensed RN Appeals Nurse

Job Summary

A company is looking for a Nurse Specialist II, Clinical Denials.

Key Responsibilities

• Review medical record documentation to verify medical necessity issues related to claims
• Create detailed clinical analyses and appeal letters to support payment of patient claims
• Provide feedback to supervisors regarding identified issues for ongoing training and improvement

Required Qualifications

• Licensed RN
• At least 2 years' experience in an acute care hospital
• Three to five years of experience in utilization review, case management, or related fields preferred
• Experience using InterQual and Milliman healthcare criteria preferred
• Proficient typing and computer skills essential