RN Appeals Nurse Consultant

Job Summary

A company is looking for an Appeals Nurse Consultant.

Key Responsibilities

• Process medical necessity of Medicare Part C appeals from members and providers
• Collaborate with internal and external partners to gather and evaluate necessary information for appeals
• Provide written recommendations or decisions based on clinical information while adhering to guidelines

Required Qualifications

• Active and unrestricted RN licensure in the state of residence
• 3+ years of clinical experience
• Associate's Degree in Nursing required; Bachelor's Degree preferred
• Experience in appeals, utilization review, or Medicare is preferred