Virtual Appeals Clinical Review Nurse in Silver Spring

Job ID: Available for Members

Location: Maryland

Compensation: To Be Discussed

Posted: Wednesday, February 21, 2018

Job Category: Consulting, Healthcare, Nursing

Telecommute Level: 100% Telecommute

Travel Requirements: No Travel

Weekly Hours: Day Shift, Full Time

Employment Status: Temporary

Employer Type: Staffing Agency

Career Level: Experienced

Education Level: Bachelors

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