RN Appeals Nurse Consultant

A company is looking for an Appeals Nurse Consultant.

Key Responsibilities

Process medical necessity appeals for Medicare Part C from members and providers

Collaborate with internal and external partners to gather and evaluate necessary information

Provide written recommendations based on clinical data while adhering to guidelines

Required Qualifications

Active and unrestricted RN licensure in state of residence

3+ years of clinical experience

Associate's Degree in Nursing required; Bachelor's Degree preferred

Experience in appeals, utilization review, or Medicare is preferred