New Mexico RN Clinical Appeals Nurse

Job Summary

A company is looking for an RN Clinical Appeals Nurse.

Key Responsibilities

• Conducts clinical reviews of denied cases and evaluates medical claims and records
• Applies clinical guidelines and collaborates with the Chief Medical Officer on denial decisions
• Serves as a clinical resource and provides training for less experienced staff

Required Qualifications

• Graduate from an Accredited School of Nursing; Bachelor's degree in Nursing 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, including acute care