Nevada Licensed Appeals Nurse

Job Summary

A company is looking for an Appeals Nurse.

Key Responsibilities

• Facilitate medical necessity appeals and denials, including reviewing clinical information and preparing case reviews for the Medical Director
• Generate appeal resolution communications and maintain the appeals process within NCQA timeframes
• Assist in revising and creating policies to meet NCQA and contractual requirements

Required Qualifications

• Current RN or LPN license; RN preferred
• 3+ years of clinical nursing experience for LPN or 2+ years for RN
• Experience with utilization or appeals review preferred
• Knowledge of InterQual criteria strongly preferred
• Ability to work within Pacific Standard Time