Job Summary
A staffing company needs applicants for an opening for a Virtual Appeals Clinical Review Nurse in Silver Spring.
Core Responsibilities of this position include:
- Reviewing provider and member appeals of denials and flag key information prior to external review
- Ensuring delivery of medically necessary, appropriate, timely, cost-effective and quality health care services
- Supporting health plan operations
Required Skills:
- Three years of utilization management or discharge planning
- Graduate of an accredited school of nursing
- Active unrestricted RN license in the State of Arizona
- Clinical experience in medical/surgical or specialty care
- Knowledge of managed care delivery systems
- Knowledge of quality improvement
