Registered Nurse - Clinical Appeals Specialist
VirtualVocationsBoca Raton, Florida, United Statesjob_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_description
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)
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Clinical Nurse Specialist • Boca Raton, Florida, United States
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