RN Clinical Appeals Specialist

A company is looking for a Clinical Appeals RN - Remote.

Key Responsibilities

Perform initial assessments of appeals, medical records, and compliance with coverage criteria

Identify additional information needed to process appeals and adapt to changes in appeal types

Utilize clinical judgment and critical thinking to make decisions on administrative nurse level cases

Required Qualifications

Current, valid, and unrestricted RN licensure in the state of residence

2+ years of clinical experience in acute care or outpatient settings

1+ years of experience in Utilization Review or Medicaid / Medicare appeals

Understanding of billable services and claims in a managed care environment

Access to high-speed internet and ability to work 8-5 within the EST time zone