Job Summary
A software development company is filling a position for a Remote Clinical Appeals Registered Nurse.
Core Responsibilities Include:
- Reviewing medical records and preparing clinical appeals
- Preparing professional, effective clinical appeals in response to managed care, governmental, or RAC denials for hospital clients
- Participating in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials
Applicants must meet the following qualifications:
- Current state RN licensure
- Bachelor of Science degree in Nursing
- At least 5 years of clinical experience in acute care setting
- Proficiency in medical record review
- Proficiency with MS Word
- At least 3 years of case management, concurrent review or utilization management experience
