West Virginia Licensed Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Coordinator, RN.

Key Responsibilities

• Conducts and leads investigations and reviews for member and provider medical necessity appeals
• Reviews medical records of denied services and ensures compliance with appeal timeframes
• Documents case information and generates written responses to members or providers

Required Qualifications

• Bachelor of Science in Nursing from an accredited program with an active nursing license
• Five years of clinical experience, including two years in case management or utilization review
• Medical management experience is preferred