Remote Licensed Clinical Appeals Nurse

Job Summary

A health services company is filling a position for a Remote Clinical Appeals Nurse.

Candidates will be responsible for the following:

• Preparing professional, effective clinical appeals in response to managed care, governmental, or RAC denials for hospital clients
• Utilizing industry guidelines, Medicare Benefit Policy Manual guidelines, and national coverage determinations,
• Participating in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials

Applicants must meet the following qualifications:

• Bachelor of Science degree in Nursing and Current state RN licensure
• At least 3 years of case management, concurrent review or utilization management experience
• At least 5 years of clinical experience in acute care setting
• Proficiency in medical record review
• Superior written communication skills
• Proficiency with MS Word; Payer case management experience is preferred