Maryland Licensed Clinical Appeals NurseVirtualVocations • Irvine, California, United States
Maryland Licensed Clinical Appeals Nurse
VirtualVocations • Irvine, California, United States
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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
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