Registered Nurse Appeals Consultant

Job Summary

A company is looking for an Appeals Nurse Consultant - Fully Remote.

Key Responsibilities

• Administers review and resolution of clinical complaints and appeals
• Interprets clinical data to apply appropriate criteria and policies in compliance with regulations
• Coordinates clinical resolutions with internal and external support areas

Required Qualifications

• Registered Nurse with an unrestricted license in the state of residence
• 3+ years of clinical nursing experience, with 1-3 years in managed care or related fields
• 1+ year of experience with ICD-9, CPT coding, and HCPC
• 1+ years of knowledge of clinical and medical policy, MCG, InterQual, and applicable regulations
• Associate degree in Nursing required; BSN preferred