California Licensed Clinical Review RN

Job Summary

A company is looking for a Clinical Review RN - Appeals.

Key Responsibilities

• Reviews provider disputes/appeals across Medi-Cal, Medicare, and commercial lines of business
• Handles an average of 8 provider appeals per day after training
• Works in a collaborative, supportive team environment without member or provider interfacing

Required Qualifications

• Graduate of an Accredited School of Nursing or BSN with 2-4 years related experience
• California RN license required
• 3 years Utilization Management (UM) experience required
• Preferred: Appeals experience; InterQual knowledge/use
• Strong computer literacy