Louisiana Licensed Clinical Appeals RN

Job Summary

Working remotely, the part-time Louisiana Licensed Clinical Appeals RN will conduct reviews of member and provider appeals, analyze claim adjustments, and ensure compliance with policies and regulations, while being available to work on Saturdays until 5 PM in their residing time zone.

Key responsibilities

• Conducts reviews of member and provider appeals
• Analyzes claim adjustment and claim history
• Reviews denied services to render appropriate approvals based on clinical criteria

Required qualifications

• Active, unrestricted RN license in the state of residence
• 5+ years of clinical experience as an RN in an acute, inpatient hospital setting
• Experience with utilization management, pre-authorization, concurrent review, or appeals
• Proficiency in Microsoft Office applications
• Ability to work on Saturdays and until 5 PM in their residing time zone