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New York Licensed Clinical Appeals Specialist
VirtualVocationsSanta Ana, California, United Statesjob_description.job_card.1_day_ago
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A company is looking for a Clinical Denials & Appeals Specialist (Remote).
Key Responsibilities
Review and respond to Corporate Compliance Audits and denial trends
Prepare and defend level of care and medical necessity for assigned cases
Collaborate with healthcare professionals to facilitate appropriate level of care decisions and ensure compliance with regulations
Required Qualifications
Graduate from an accredited School of Nursing
Bachelor's Degree in Nursing preferred
Must be enrolled in an accredited BSN program within two years and obtain a BSN Degree within five years
Current License to practice as a Registered Professional Nurse in New York State required
3-5 years of experience in Utilization Review, Case Management, and Clinical Appeals preferred
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