State Licensed Appeals Nurse

Job Summary

A company is looking for an Appeals Nurse to join their Specialty Appeals Team.

Key Responsibilities

• Adhere to company policies and procedures in utilization and appeals management
• Document communications with medical staff and interface with other departments to resolve appeal-related issues
• Provide customer service and collaborate with Clinical Reviewers for timely adjudication of appeals

Required Qualifications, Training, and Education

• 1-3 years of experience as a Registered Nurse (RN) - Required
• Minimum of 5 years in Utilization Management or healthcare appeals - Required
• Able to work in a rotation from 10:30am to 7pm CST and 8am - 5pm EST/CST - Required
• Preferred ability to exercise independent judgment in clinical decision-making
• Preferred experience with Microsoft Office and strong organizational skills