Registered Nurse Clinical Appeals Specialist

A company is looking for a UR Registered Nurse - Clinical Appeals & Denials Specialist.

Key Responsibilities

Manage clinical denials from providers to health plans, including analyzing and processing medical necessity denials

Draft and submit medical necessity determinations based on clinical documentation reviews

Identify denial patterns and escalate potential risks to clients and leadership

Required Qualifications

Registered Nurse (RN) educational background

2-3 years of clinical and utilization management experience with managed health care plans

3 years of experience in health care revenue cycle or clinic operations

Experience in utilization management, including clinical appeals and grievances

Intermediate knowledge of Microsoft Office (Excel, Word, Outlook)