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)
Registered Nurse • Albuquerque, New Mexico, United States