West Virginia Licensed Appeals Nurse

A company is looking for a Clinical Appeals Coordinator, RN.

Key Responsibilities

Conducts and leads investigations and reviews for member and provider medical necessity appeals

Reviews medical records of denied services and ensures compliance with appeal timeframes

Documents case information and generates written responses to members or providers

Required Qualifications

Bachelor of Science in Nursing from an accredited program with an active nursing license

Five years of clinical experience, including two years in case management or utilization review

Medical management experience is preferred