State Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse to support patients and healthcare providers by evaluating appeals and disputes.

Key Responsibilities:

• Analyze medical records and case files to produce objective summaries for dispute resolution
• Make evidence-based decisions in accordance with legal statutes and clinical standards
• Respond to issues raised by patients and healthcare providers involved in appeals

Required Qualifications:

• Associate's degree or higher in a healthcare-related field from an accredited institution
• LPN or RN License
• Minimum of three years' experience in medical appeals or clinical review
• Background in Nursing, Physical Therapy, Occupational Therapy, or Respiratory Therapy
• Possession of a coding certification is a plus