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 data from clinical records
• Apply appropriate clinical criteria and policies in accordance with regulatory requirements
• Coordinate clinical resolutions with internal and external clinician support as necessary

Required Qualifications

• Active and unrestricted RN licensure in state of residence
• 3+ years of clinical experience
• Associate's Degree minimum
• Experience in appeals and managed care preferred
• Utilization review experience is a plus