Registered Nurse Appeals Consultant

Job Summary

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

Key Responsibilities

• Administer review and resolution of clinical complaints and appeals
• Interpret data from clinical records to apply clinical criteria and policies in compliance with regulations
• Coordinate clinical resolutions with internal and external support areas

Required Qualifications

• Registered Nurse with an unrestricted license in their state of residence and multi-state/compact privileges
• 3+ years of clinical nursing experience, including 1-3 years in managed care or Utilization Review
• 1+ year of experience with ICD-9, CPT coding, and HCPC
• 1+ years of knowledge of clinical and medical policy, including MCG and InterQual guidelines
• Associate degree in Nursing required; BSN preferred