Licensed RN Appeals Nurse

Job Summary

Working remotely, the Licensed RN Appeals Nurse will review and appeal clinical denials from Medicare, Medicaid, and other payers, creating detailed analyses and managing accounts in a part-time capacity.

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 issues identified for ongoing training to peers and non-clinical staff

Required qualifications

• Licensed RN with at least 2 years of 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
• Familiarity with CMS LCD/NCD criteria preferred
• Proficient typing and computer skills essential