Missouri Licensed Clinical Appeals RN
Job Summary
Advocating for patients through appeals, the full-time Missouri Licensed Clinical Appeals RN will work remotely to manage infusion denial cases, collaborating with an interdisciplinary team to enhance patient satisfaction and ensure appropriate care levels.
Key responsibilities
- Utilize clinical and analytical skills to review diagnostic test results for appropriateness of care
- Apply Interqual Criteria to assess the level of care for elective inpatient hospitalizations
- Educate medical providers on the effective use of healthcare resources and cost management
Required qualifications
- Current RN license in Missouri
- Minimum of 1 year of experience in Utilization Review, Case Management, or Clinical Appeals
- Nursing Diploma or Associate's Degree in Nursing
- 2-5 years of nursing experience
- Ability to work Monday through Friday, 8am-5pm
Complete Job Description
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