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 necessary clinical information
• Prepare written recommendations for MD review based on clinical data and documentation

Required Qualifications

• Active and unrestricted RN licensure in state of residence
• 3+ years of clinical experience
• Associates Degree in Nursing required; Bachelor's Degree preferred
• Experience in appeals and utilization review is preferred
• Medicare experience is a plus