Registered Nurse - Clinical Appeals Specialist

A company is looking for a Registered Nurse - Clinical Appeals & Denials Specialist - Remote.

Key Responsibilities

Manage clinical denial cases, including analyzing and processing medical necessity denials

Draft and submit medical necessity determinations based on clinical documentation reviews

Document claims and appeals information in relevant tracking systems and identify denial patterns

Required Qualifications

Registered Nurse (RN) educational background

2-3 years of combined 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)