Clinical Appeals Care Coordinator RN

A company is looking for a Care Coordinator - Clinical Appeals RN.

Key Responsibilities

Perform medical necessity reviews for inpatient, outpatient, and retrospective cases to ensure compliance with medical policies and eligibility

Consult with Medical Directors regarding cases that do not meet established criteria

Document clinical information accurately and maintain understanding of provider contracts and clinical criteria

Required Qualifications

Bachelor's degree or four years of relevant work experience (REQUIRED)

Current State Licensure as a registered nurse (REQUIRED)

Three years of clinical experience (REQUIRED)

Utilization Management experience

Experience working in the health plan industry