Virginia Licensed Clinical Nurse

Job Summary

A company is looking for a Registered Nurse (RN) Clinical Denials and Appeals to join their team.

Key Responsibilities

• Support the program for retro Medicaid claims and post-admission retro claims
• Review denied claims to assess clinical care appropriateness and determine appeal necessity
• Collaborate with various departments to ensure accurate documentation for appeals and provide education on best practices

Required Qualifications

• Bachelor's degree or equivalent of Associate's degree with RN license
• Three years of RN licensed experience in a clinical or hospital setting
• RN license or licensed to practice in the Commonwealth of Virginia as an RN