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, support non-clinical staff with administrative denials, and maintain accurate tracking of appeals through various tools.

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
• Serve as a clinical resource for non-clinical staff regarding administrative denials and coding-related appeals

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 in a health insurance or payer environment preferred
• Experience with quality improvement initiatives is a plus