Registered Nurse Appeals Consultant

A company is looking for an Appeals Nurse Consultant - Fully Remote.

Key Responsibilities

Administers review and resolution of clinical complaints and appeals

Interprets clinical data to apply appropriate criteria and policies in compliance with regulations

Coordinates clinical resolutions with internal and external support areas

Required Qualifications

Registered Nurse with an unrestricted license in the state of residence

3+ years of clinical nursing experience, with 1-3 years in managed care or related fields

1+ year of experience with ICD-9, CPT coding, and HCPC

1+ years of knowledge of clinical and medical policy, MCG, InterQual, and applicable regulations

Associate degree in Nursing required; BSN preferred