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North Carolina Licensed Clinical Appeals Specialist RN

5/30/2025

Remote

Job Summary

A company is looking for a Clinical Appeals Specialist RN.

Key Responsibilities
  • Coordinate and manage the Medicaid and Non-Medicaid denial and appeals processes
  • Prepare clinical documentation and represent the organization during mediation and appeals hearings
  • Maintain accurate records and assist in data collection and reporting related to appeals
Required Qualifications, Training, and Education
  • Bachelor's degree in Nursing with active RN licensure in North Carolina
  • Two years of post-degree professional experience
  • Knowledge of behavioral health and physical health conditions
  • Experience in data collection and analysis
  • Proficiency in Microsoft Office Suite and relevant reporting systems

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