State Licensed Appeals Nurse Consultant

Job Summary

A company is looking for a Utilization Management Appeals Nurse Consultant (Remote).

Key Responsibilities

• Administers review and resolution of clinical complaints and appeals
• Interprets data from clinical records to apply appropriate clinical criteria and policies
• Coordinates clinical resolutions with internal and external support areas

Required Qualifications

• Active, unrestricted RN license in the state of residence
• 3+ years of Utilization Management or Utilization Review experience
• 1+ year of experience with clinical and medical policy, including Milliman Care Guidelines (MCG) and InterQual
• 3+ years of clinical nursing experience, with 1-3 years in managed care or related fields
• 1+ year of experience with ICD-9, CPT coding, and HCPC