New Jersey Licensed Appeals Analyst RN

Job Summary

A company is looking for an Appeals Resolution Analyst II-RN.

Key Responsibilities

• Handle Utilization Management medical appeal cases and ensure compliance with regulatory requirements
• Evaluate clinical needs and appropriateness of medical services, preparing records for review as necessary
• Investigate and resolve complicated appeals while providing support to appeals staff and conducting presentations on the appeals process

Required Qualifications

• High School Diploma/GED required; Bachelor's degree in health care management preferred
• 2 years of clinical experience required
• 3 years of experience in the health care delivery system/industry required
• Registered Nurse License required
• Working knowledge of principles of utilization management and health care contracts