Ohio Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse.

Key Responsibilities

• Process clinical appeals and attend state hearings in compliance with regulatory standards
• Perform clinical reviews of member and provider appeals across various service areas
• Document clinical rationale and communicate outcomes effectively to stakeholders

Required Qualifications, Training, and Education

• Associate's Degree required
• Managed care, appeals, Medicare, and Medicaid experience preferred
• Prior clinical appeals and/or Utilization review experience strongly preferred
• Current, unrestricted license as a Registered Nurse (RN) required
• MCG Certification required or must be obtained within six months of hire