Wisconsin Licensed Clinical Appeals RN

Job Summary

Seeking a Wisconsin Licensed Clinical Appeals RN to work remotely in a full-time capacity, responsible for reviewing appeals and provider inquiries for clinical eligibility, performing medical reviews, and ensuring adherence to confidentiality regulations.

Key responsibilities:

• Perform medical reviews on provider inquiries and member appeals
• Ensure compliance with Department of Labor and State guidelines
• Accurately document determinations and interpret plan language

Required qualifications:

• Active, unrestricted RN licensure in the state of residence
• 5+ years of RN experience in an acute care inpatient facility
• Intermediate Microsoft skills (MS Word and Outlook)
• Designated quiet workspace in your home
• Access to secure high-speed internet in the home