RN Appeals Nurse Consultant

Job Summary

A company is looking for an Appeals Nurse Consultant.

Key Responsibilities

• Process Medicare Part C appeals from members and providers, ensuring adherence to guidelines
• Collaborate with internal and external partners to gather and evaluate necessary information
• Prepare written recommendations and decisions based on clinical information and documentation

Required Qualifications

• Active and unrestricted RN licensure in state of residence
• 3+ years of clinical experience
• Associate's degree in Nursing; Bachelor's degree preferred
• Experience in appeals, utilization review, or Medicare preferred