Virginia Licensed RN Clinical Appeals

A company is looking for an RN Clinical Appeals.

Key Responsibilities

Review denials and perform root cause analysis to improve processes and reduce denials

Contact insurance plans to determine reasons for claim denials and prepare necessary appeal materials

Act as a liaison between healthcare providers and ensure timely communication of denial trends and outcomes

Required Qualifications

Current unrestricted license to practice nursing (LPN, RN)

CRCR or other approved professional certification required within 9 months of hire

1 to 3 years of relevant experience

Associate's Degree or equivalent experience in Nursing

Preferred : 2 years of experience in denials, utilization review, or case management