Remote Clinical Appeals Nurse (RN)

Job Summary

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

Key Responsibilities

• Perform clinical/medical reviews of retrospective medical claim reviews and previously denied cases
• Document clinical review summaries and provide supporting documentation for denial and modification of payment decisions
• Assist with complex claim reviews and identify quality of care issues

Required Qualifications

• Graduate from an Accredited School of Nursing; Bachelor's degree in Nursing preferred
• 3-5 years clinical nursing experience, with 1-3 years in Managed Care
• Knowledge of ICD-9, CPT coding, HCPC, and CMS Guidelines
• Active, unrestricted State Registered Nursing (RN) license in good standing
• Preferred: 5+ years Clinical Nursing experience, including hospital acute care/medical experience