Registered Nurse - Remote

A company is looking for a Registered Nurse - Remote.

Key Responsibilities

Manage clinical denials and analyze medical necessity denials for resolution

Draft and submit medical necessity determinations based on clinical documentation reviews

Document claims and appeals information accurately in relevant tracking systems

Required Qualifications

Registered Nurse (RN) educational background

2-3 years of clinical and / or utilization management experience with managed health care plans

3 years of experience in health care revenue cycle or clinic operations

Experience in utilization management, including Clinical Appeals and Grievances

Intermediate knowledge of Microsoft Office (Excel, Word, Outlook)