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RN Appeals Medical Review NurseVirtualVocations • Chesapeake, Virginia, United States
RN Appeals Medical Review Nurse

RN Appeals Medical Review Nurse

VirtualVocations • Chesapeake, Virginia, United States
8 days ago
Job type
  • Full-time
Job description
Utilizing clinical expertise, the full-time RN Appeals Medical Review Nurse will review medical documentation for necessity and appropriateness of care, ensuring compliance with MCG/InterQual and relevant regulations while working remotely on a PST schedule. Key responsibilities Facilitates medical review of appeals for denied prior authorizations across various cases, including inpatient and outpatient Reevaluates medical claims and records to assess appropriateness of services and ensure accurate billing Serves as a clinical resource for utilization management and provides training and support to clinical peers Required qualifications At least 2 years of clinical nursing experience, with 1 year in utilization review or medical claims review Active and unrestricted Registered Nurse (RN) license in the state of practice Knowledge of ICD-10, CPT coding, and HCPC Experience with state, federal, and third-party regulations Analytic and decision-making skills relevant to clinical assessments
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RN Appeals Medical Review Nurse • Chesapeake, Virginia, United States

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