Job Summary

A healthcare company needs applicants for an opening for a Remote Clinical Appeals Specialist II in Antioch.

Candidates will be responsible for the following:

• Filing medical necessity and level of care appeals using InterQual and CMS guidelines as needed
• Monitoring clinical appeal processes for issues and trends and provide guidance and feedback
• Tracking and managing clinical denials using current tools

Applicants must meet the following qualifications:

• Understanding and utilization of medical necessity criteria for inpatient and outpatient services
• Ability to define problems, collect data, validate data, establish facts, and draw valid conclusions
• Microsoft Office skills
• RN with current license to practice in state
• Must have diploma/degree from an accredited school of nursing
• 5 years of clinical nursing experience