RN Appeals Nurse Consultant

Job Summary

A company is looking for an Appeals Nurse Consultant to work from home.

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 recommendations based on clinical data
• Review and prepare appeals for medical 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