RN Appeals Nurse Consultant

Job Summary

A company is looking for an Appeals Nurse Consultant (Remote).

Key Responsibilities

• Review and resolve clinical appeals by interpreting clinical records and applying appropriate criteria
• Independently coordinate clinical resolutions with internal and external clinician support as needed
• Support various types of appeals including UM, MPO, Coding, or Behavioral Health

Required Qualifications

• Active and unrestricted RN licensure in the state of residence
• 3+ years of clinical experience
• Associate's Degree minimum
• Preferred experience in appeals and managed care
• Utilization review experience is advantageous