Medical Doctor medical license or be a registered nurse with strong appeals experience. 2 years of clinical experience with inpatient care. Knowledge of, or experience in working with the verbal and written appeals process. Must have experience with electronic medical record systems.
Required A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field. Required 2 years of experience in directly related HEDIS medical record review and/or Quality Improvement.
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