New Jersey Licensed Appeals Analyst RN

Job Summary

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

Key Responsibilities

• Assess patients' clinical needs against established guidelines to ensure appropriate care levels
• Evaluate the necessity and efficiency of medical services and procedures by inpatient facilities
• Investigate and resolve complicated appeals, coordinating with the legal department as necessary

Required Qualifications, Training, and Education

• 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