Job Summary
A healthcare services company is seeking a Telecommute Compliance Nurse in Nashville.
Must be able to:
- Present a concise medical summary within each appeal based on support from the medical record
- Contact appropriate parties (internal and/or external) for additional information to properly formulate the clinical appeal
- Compose clinical appeal letters to send to payers for denial reconsiderations
Skills and Requirements Include:
- At least one-year case management experience required
- Demonstrate understanding of use of all Medical Necessity software, including but not limited to InterQual
- Demonstrate an ability to interpret medical payer policy requirements
- Strong ability to research evidence-based practices
- State RN or LPN License required (Active/Inactive)
- Relevant education may substitute experience requirement
