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Registered Nurse Clinical Appeals Specialist
VirtualVocationsSaint Petersburg, Florida, United Statesjob_description.job_card.variable_days_ago
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- serp_jobs.job_card.full_time
job_description.job_card.job_description
A company is looking for a UR Registered Nurse - Clinical Appeals & Denials Specialist.
Key Responsibilities
Manage clinical denials from providers to health plans, including analyzing and processing medical necessity denials
Draft and submit medical necessity determinations based on clinical documentation reviews
Identify denial patterns and escalate potential risks to clients and leadership
Required Qualifications
Registered Nurse (RN) educational background
2-3 years of clinical and 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)
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Nurse Clinical Specialist • Saint Petersburg, Florida, United States
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