California Licensed Clinical Appeals RN

A company is looking for a Clinical Appeals RN to work remotely in the EST or CST time zone.

Key Responsibilities

Perform initial assessment reviews of appeals and medical records to determine coverage eligibility

Identify additional information needed for processing appeals and adapt to various appeal types

Utilize clinical nursing judgment and critical thinking to make decisions on administrative nurse level cases

Required Qualifications

Current, valid, and unrestricted RN licensure in the state of residence

2+ years of clinical experience in an acute care or outpatient setting

1+ years of experience in Utilization Review, Medicaid, or Medicare appeals

Understanding of billable services and claims in a managed care environment

Access to high-speed internet and ability to work 8-5 within the EST time zone