State Licensed Appeals Nurse Consultant

Job Summary

A company is looking for an Appeals Nurse Consultant.

Key Responsibilities

• Request and research provider clinical information to support case reviews and determinations
• Review documentation to identify relevant clinical details and apply CMS guidelines and regulatory requirements
• Prepare comprehensive nurse summaries for medical director evaluation or finalize appeal determinations

Required Qualifications

• 3-5 years of experience as a Registered Nurse
• Minimum 3+ years of clinical/hospital nursing experience
• Active RN State License required
• Associate's degree or Diploma RN required; BSN preferred
• 1+ years in Medicare Utilization Management, case review, or prior authorization preferred