Job Summary
A staffing company is filling a position for a Telecommute Appeals and Clinical Review Nurse.
Candidates will be responsible for the following:
- Supporting health plan operations to ensure delivery of medically necessary, quality healthcare services
- Reviewing provider and member appeals of denials
- Flagging key information prior to external review
Position Requirements Include:
- Graduate of an accredited school of nursing
- Active unrestricted RN license in the State of UT
- Excellent verbal and written communication skills
- Three years of utilization management or discharge planning
- Clinical experience in medical/surgical or specialty care and at least one year of Appeals experience
- Knowledge of managed care delivery systems
