Job Summary
A software development company is seeking a Remote PRN Appeals Nurse .
Core Responsibilities Include:
- Prepare professional, effective clinical appeals in response to managed care, governmental, or RAC denials for hospital clients
- Utilize various guidelines in reviewing medical records and writing appeals
- Participate in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials
Qualifications for this position include:
- Bachelor of Science degree in Nursing
- At least 3 years of case management, concurrent review or utilization management experience
- At least 5 years of clinical experience in acute care setting
- Current state RN licensure
- Proficiency in medical record review
