Oklahoma Licensed Appeal Nurse

Job Summary

A company is looking for an Appeal Nurse Associate - Remote.

Key Responsibilities

• Facilitate the delivery of healthcare information and benefits eligibility while promoting wellness activities
• Review and resolve clinical complaints, grievances, and appeals, ensuring compliance with regulatory and accreditation standards
• Coordinate clinical resolutions and gather data from multiple sources to support appeal determinations

Required Qualifications

• 2+ years of clinical experience
• LPN/LVN with current unrestricted state licensure in state of residence
• Knowledge of clinical criteria, benefit plan structures, and regulatory requirements
• Experience in navigating multiple system applications
• Ability to condense information from various sources into a clear clinical picture