Maryland Licensed Appeals RN

Job Summary

Responsible for managing medical appeals, the full-time Maryland Licensed Appeals RN will conduct reviews of clinical appeals, document findings, and collaborate with Medical Directors while working remotely.

Key responsibilities

• Facilitates and manages medical appeals, ensuring compliance with regulatory and accreditation standards
• Conducts initial medical record reviews for clinical appeals and prepares summaries for Medical Director review
• Documents all appeals and reviews in the clinical software system, maintaining accurate and secure records

Required qualifications

• Bachelor's degree in Nursing
• 5-7 years of diverse clinical experience, with knowledge of authorization processes
• 1-2 years of recent utilization review experience
• Active and unrestricted Nursing License in Maryland or the District of Columbia
• No prior or current Medicare or Medicaid sanctions