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Online Registered Nurse Appeals Representative

Job is Expired
Location: New Jersey
Compensation: To Be Discussed
Staff Reviewed: Mon, Sep 13, 2021
Job Category: Healthcare
Weekly Hours: Full Time
Employer Type: Employer
Career Level: Experienced

Job Summary

A health organization has a current position open for a Online Registered Nurse Appeals Representative.

Individual must be able to fulfill the following responsibilities:

  • Review patient medical records and utilize clinical and regulatory knowledge and skills
  • Construct and document a succinct and fact based clinical case to support appeal utilizing appropriate medical criteria
  • Review requirements to determine why cases are denied and whether an appeal

Position Requirements Include:

  • Must possess a valid nursing license (Current, valid RN/LPN/LVN licensure
  • Must possess MCG UM Certification or obtain within 6 months of employment
  • Minimum of 5 years recent acute care experience with the last 2 years in a facility environment
  • Minimum of 2 years UR/UM/CM
  • Must have proficiency with online nationally recognized UM criteria

COMPLETE JOB DESCRIPTION

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