Nevada Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse - PST Hours Required.

Key Responsibilities

• Process clinical appeals and attend state hearings in compliance with standards
• Conduct clinical reviews of member and provider appeals across various services
• Document clinical rationale and communicate outcomes effectively to stakeholders

Required Qualifications, Training, and Education

• Associate's Degree required
• Managed care, appeals, Medicare, and Medicaid experience preferred
• Prior clinical appeals and/or Utilization review experience strongly preferred
• Current, unrestricted license as a Registered Nurse (RN) is required
• MCG Certification is required or must be obtained within six months of hire