State Licensed Med Surg Nurse

Job Summary

A company is looking for a Med Surg Nurse / Psych Nurse.

Key Responsibilities

• Analyze written appeals and draft detailed response letters addressing complex issues
• Prepare appeal cases for physician review and communicate final decisions to members and providers
• Utilize clinical judgment to assess adverse decisions and ensure compliance with regulations

Required Qualifications

• High School Diploma or equivalent
• 2 years of clinical experience in a medical-surgical or similar setting or 3 years in mental health or psychiatric care
• Active RN license (state or compact)
• BSN or MSN degree preferred
• Experience in Medical Review, Utilization Management, or Case Management preferred