Job Summary

We have an immediate need for experienced Registered Nurses (RN) with at least one year of Appeals experience.

The right candidate will have the ability to review provider and member appeals of denials and flag key information prior to external review. The Appeals/Clinical Review Nurse supports health plan operations to ensure delivery of medically necessary, appropriate, timely, cost-effective and quality health care services.

Educational requirements:

Active and Unrestricted RN Licensure in the state of residence
Graduate of an accredited school of nursing
This immediate opening is a temporary position lasting three (3) months

Hours Monday - Friday 8:30 am - 5 pm

No weekends or evenings

Qualifications and Skills

Three years of utilization management or discharge planning
Clinical experience in medical/surgical or specialty care(occupational health rehabilitation, orthopedic, or neurological surgical nursing)
Knowledge of managed care delivery systems
Independent decision making
Knowledge of quality improvement
Excellent verbal and written communication skills
Orientation to detail
Ability to work under tight timelines
Coding experience preferred


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