RN Utilization Management Nurse
Job Summary
To support a dynamic team, the remote Utilization Management Appeals Nurse (RN) will review patient medical records, analyze denial cases, and develop evidence-based appeal letters while ensuring adherence to quality and productivity standards.
Key responsibilities:
- Review and analyze patient medical records and denial documentation
- Extract pertinent clinical information to develop strong, defensible appeal letters
- Collaborate with interdisciplinary teams to support successful appeal outcomes
Required qualifications:
- Active RN license
- 3+ years of bedside nursing experience in Adult ED, Telemetry, ICU, or CCU settings
- Strong clinical assessment and critical thinking skills
- Proficiency with Microsoft Word and electronic medical records
- Ability to work independently in a fast-paced remote environment
Complete Job Description
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