Registered Nurse - Remote

A company is looking for a Registered Nurse - Remote.

Key Responsibilities

Manage clinical denial processes and analyze medical necessity denials for resolution

Draft and submit medical necessity determinations in accordance with guidelines

Document claims and appeals information and identify denial patterns to mitigate risks

Required Qualifications

Registered Nurse (RN) educational background

2-3 years of clinical and / or 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 precertification

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