Job Summary
A healthcare company has an open position for a Telecommute Clinical Appeals Nurse in Nashville.
Core Responsibilities Include:
- Presenting a concise medical summary within each appeal based on support from the medical record
- Composing clinical appeal letters to send to payers
- Updating the patient account record to identify actions taken on the account
Must meet the following requirements for consideration:
- Strong ability to research evidence-based practices
- Demonstrate understanding of use of all Medical Necessity software, including but not limited to InterQual
- Demonstrate ability to interpret medical payer policy requirements
- At least one year case management experience required, relevant education may substitute experience requirement
- State RN or LPN License required
