Maryland Licensed Appeals Nurse

Job Summary

Responsible for the timely review and resolution of clinical appeals, the full-time Maryland Licensed Appeals Nurse will work remotely to communicate appeal determinations and support non-clinical staff with administrative denials and coding-related appeals.

Key responsibilities

• Review and resolve clinical appeals submitted by providers and members across all lines of business
• Communicate appeal determinations in accordance with regulatory requirements
• Maintain accurate tracking of appeals through logs, databases, and reporting tools

Required qualifications

• Current Registered Nurse (RN) license in the State of Maryland
• Graduate of an accredited school of nursing; BSN preferred
• Minimum of three (3) years of acute care nursing experience
• Prior experience within a health insurance or payer environment preferred
• Experience participating in quality improvement initiatives is a plus