New York Licensed Clinical Appeals Specialist

A company is looking for a Clinical Denials & Appeals Specialist (Remote).

Key Responsibilities

Review and respond to Corporate Compliance Audits and denial trends

Prepare and defend level of care and medical necessity for assigned cases

Collaborate with healthcare professionals to facilitate appropriate level of care decisions and ensure compliance with regulations

Required Qualifications

Graduate from an accredited School of Nursing

Bachelor's Degree in Nursing preferred

Must be enrolled in an accredited BSN program within two years and obtain a BSN Degree within five years

Current License to practice as a Registered Professional Nurse in New York State required

3-5 years of experience in Utilization Review, Case Management, and Clinical Appeals preferred