Arizona Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse (RN).

Key Responsibilities

• Perform clinical reviews of denied cases and re-evaluate medical claims and records
• Apply clinical knowledge and regulatory guidelines to assess service appropriateness and resolve complaints
• Provide training and mentorship to less experienced nursing and administrative staff

Required Qualifications

• Graduate from an Accredited School of Nursing; Bachelor's degree preferred
• 3-5 years of clinical nursing experience, with 1-3 years in Managed Care
• Knowledge of ICD-9, CPT coding, and CMS Guidelines
• Active, unrestricted State Registered Nursing (RN) license in good standing
• Preferred: 5+ years of clinical nursing experience and relevant healthcare certifications