Maryland Licensed Clinical Appeals Nurse

A company is looking for a Clinical Appeals Nurse (Remote).

Key Responsibilities

Investigates and analyzes written appeals and reconsideration requests, responding with detailed letters while adhering to corporate policies and regulations

Organizes appeal cases for physician review, compiling relevant information and communicating final decisions to members and providers

Utilizes nursing expertise to prioritize and assess appeal requests related to medical and behavioral health conditions, collaborating with external review organizations as necessary

Required Qualifications

High School Diploma or GED

Registered Nurse (RN) State Licensure required upon hire

2 years of medical-surgical or similar clinical experience, or 3 years in a mental health setting

Certified Case Manager (CCM) and / or Legal Nurse Consultant Certified (LNCC) preferred upon hire

Preferred BSN or MSN degree