Job Summary

A staffing firm has an open position for a Remote Clinical Appeals Registered Nurse.

Core Responsibilities of this position include:

• Reviewing member and provider appeals submitted from Customer and Provider Services
• Creating episodes in UM system for management and documentation of the clinical review process
• Reviewing correspondence and medical records autonomously using sound judgment and good decision making

Applicants must meet the following qualifications:

• Valid Idaho Registered Nurse License
• One-year of clinical appeals experience
• One-year of utilization management / discharge planning