New Jersey Licensed Appeals Analyst RN
Job Summary
Responsible for managing Utilization Management medical appeal cases, the full-time remote New Jersey Licensed Appeals Analyst RN will ensure compliance with regulatory requirements, mentor appeals staff, and perform special projects as assigned.
Key responsibilities
- Assess clinical needs against established guidelines to determine the appropriateness of inpatient care
- Investigate and resolve complicated appeals, coordinating with legal departments as necessary
- Prepare and present appeals to the Appeals Committee while ensuring compliance with regulatory standards
Required qualifications
- High School Diploma/GED required; Bachelor's degree in healthcare management preferred
- 2 years of clinical experience required
- 3 years of experience in the healthcare delivery system/industry required
- Current Registered Nurse License required
- Working knowledge of principles of utilization management and healthcare contracts
Complete Job Description
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