Indiana Licensed Appeals Nurse

Job Summary

A company is looking for a Registered Nurse, Appeals - Remote.

Key Responsibilities:

• Communicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation and appeal letters
• Facilitate the appeals process by composing clinical appeals letters and ensuring all documentation is obtained prior to submission
• Utilize multiple internal processing systems for record keeping and tracking of appeal determinations

Required Qualifications:

• Active, Registered Nurse License
• Willingness to obtain Case Management Certification (CCM) once eligible
• 1+ years of experience with prior authorization, pre-certification, utilization review, and/or appeals
• Proven understanding of clinical documentation from physician offices
• Proficiency with MS Word, Excel, and Point