Missouri Licensed Clinical Appeals RN

Job Summary

A company is looking for a Clinical Appeals RN.

Key Responsibilities

• Review and interpret diagnostic test results to determine appropriateness of patient's level of care
• Utilize Interqual Criteria to determine level of care for elective inpatient hospitalizations
• Advocate for patients by appealing denials on their behalf to insurance companies

Required Qualifications

• Nursing Diploma or Associate's Degree in Nursing
• 2-5 years of relevant nursing experience
• Current RN license
• Experience in Utilization Review, Case Management, or Clinical Appeals preferred
• BSN is preferred