Maryland Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse (Remote).

Key Responsibilities

• Investigates and analyzes written appeals and reconsideration requests from various sources, responding with complex letters while adhering to regulations
• Organizes appeal cases for physician review by compiling relevant information and communicating final decisions to members and providers
• Utilizes nursing expertise to assess appeal requests, collaborates with independent review organizations, and responds to regulatory agency complaints

Required Qualifications

• High School Diploma or GED
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required upon hire
• 2 years of medical-surgical or similar clinical experience, or 3 years in a mental health setting
• CCM - Certified Case Manager and LNCC - Legal Nurse Consultant Certified preferred upon hire
• Preferred BSN/MSN Degree