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 office staff and resolve issues related to appeals
• Collaborate with Clinical Reviewers to ensure timely adjudication of processed appeals

Required Qualifications

• 1-3 years of experience as a Registered Nurse (RN)
• Minimum of 5 years in Utilization Management or healthcare appeals
• Able to work a rotation from 10:30 am to 7 pm CST, 3 days a week
• Ability to exercise independent judgment in clinical decision making
• Working knowledge of Microsoft Office products and ability to navigate computer systems