State Licensed RN Appeal Writer

Job Summary

A company is looking for an Independent Contractor-Hospital RN specializing in Appeal Writing and Denials Management.

Key Responsibilities

• Perform retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials
• Construct and document clinical cases to support appeals using appropriate medical necessity criteria
• Demonstrate critical thinking and decision-making skills in the clinical appeal process

Required Qualifications

• RN or MD degree with an active unrestricted clinical license in at least one U.S. state
• Minimum of 5 years recent acute-care hospital experience preferred
• Minimum of 2 years of Utilization Review or Case Management experience within the last 5 years
• Managed care payor experience in Utilization Review, Case Management, or Appeals is a plus
• Must be computer proficient