Oregon Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse (RN).

Key Responsibilities

• Conduct comprehensive clinical reviews of member and provider appeals
• Apply clinical expertise to interpret medical records and benefit plans
• Collaborate with physician advisors to validate complex clinical decisions

Qualifications

• Current, unrestricted Registered Nurse (RN) license in OR, WA, ID, or UT; Bachelor's degree in Nursing preferred
• Minimum of 2 years of experience in health insurance or clinical appeals review, plus 3 years of direct patient care experience
• Strong knowledge of medical terminology, coding systems, and clinical guidelines
• Proven ability to interpret medical records and translate findings into written determinations
• Familiarity with regulatory standards and proficiency in Microsoft Office tools