New Jersey Licensed Appeals RN

Job Summary

A company is looking for an Appeals Resolution Analyst II-RN.

Key Responsibilities:

• Assess patient's clinical needs against established guidelines for inpatient care
• Evaluate the necessity and appropriateness of medical services and procedures
• Investigate and resolve complicated appeals, coordinating with legal as needed

Required Qualifications:

• High School Diploma/GED required
• Bachelor's degree in health care management preferred or relevant experience in lieu of degree
• 2 years of clinical experience required
• 3 years of experience in the health care delivery system/industry required
• Registered Nurse License required