A company is looking for a Clinical Appeals RN - Remote.
Key Responsibilities :
Perform medical reviews on provider inquiries and member appeals
Ensure compliance with Department of Labor and State guidelines
Accurately document determinations and interpret Plan language
Required Qualifications :
Active, unrestricted RN licensure in the state of residence
5+ years of RN experience in an acute care inpatient facility
Intermediate Microsoft skills (MS Word and Outlook)
Ability to work independently with self-discipline
Access to secure high-speed internet in a designated workspace
Rn • Hialeah, Florida, United States