State Licensed Appeals Nurse Consultant

A company is looking for a Utilization Management Appeals Nurse Consultant (Remote).

Key Responsibilities

Administers review and resolution of clinical complaints and appeals

Interprets data from clinical records to apply appropriate clinical criteria and policies

Coordinates clinical resolutions with internal and external support areas

Required Qualifications

3+ years of Utilization Management or Utilization Review experience

3+ years of clinical nursing experience, with 1-3 years in managed care

1+ year of experience with ICD-9, CPT coding, and HCPC

1+ year of experience with clinical and medical policy, including Milliman Care Guidelines or InterQual

Active, unrestricted RN license in the state of residence