Job Summary
A company is looking for an Appeals Nurse Consultant - Fully Remote.
Key Responsibilities
- Process medical necessity appeals for Medicare Part C from members and providers
- Collaborate with internal and external partners to gather necessary information and provide written recommendations
- Review and prepare appeals for MD review while ensuring adherence to guidelines
Required Qualifications
- Active and unrestricted RN licensure in state of residence
- 3+ years of clinical experience
- Associate's degree or RN diploma required
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