New Jersey Licensed Appeals RN

Job Summary

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

Key Responsibilities:

• Assess patient's clinical needs against established guidelines for inpatient care
• Evaluate the necessity and appropriateness of medical services and procedures
• Investigate and resolve complicated appeals, including high priority cases and prepare presentations for the Appeals Committee

Required Qualifications:

• High School Diploma or GED required; Bachelor's degree in health care management preferred
• 2 years of clinical experience required
• Minimum 1-year experience in the health care delivery system/industry required
• Active Unrestricted RN License required; NJ License preferred
• Working knowledge of principles of utilization management preferred