Maryland Licensed RN Appeals Specialist

Job Summary

A company is looking for a Denials/Appeals Management Specialist (RN).

Key Responsibilities

• Completes appeal processes for denied medical necessity days and evaluates external denials
• Develops medical summaries for denied cases and implements strategies to avoid future denials
• Maintains records of denial activity, monitors results, and participates in educational processes for staff

Required Qualifications

• Associate's degree in Nursing required; Bachelor's degree preferred
• 2 to 3 years of clinical nursing experience required
• 2 to 3 years of experience in utilization review in a health care setting preferred
• 2 years of experience in hospital audits preferred
• RN licensure in the District of Columbia or Maryland required upon hire