RN Clinical Appeals Specialist

Job Summary

A company is looking for a Clinical Appeals RN, remote in CST, MST, or PST.

Key Responsibilities

• Analyze and review clinical appeals and grievances
• Serve as a clinical liaison to resolve issues and provide support for clinical programs
• Monitor and analyze medical management activities and perform clinical assessments

Required Qualifications

• Current, valid, and unrestricted RN licensure in the state of residence
• 5+ years of clinical experience in an acute care or outpatient setting
• 1+ year of experience in Utilization Review or Medical Appeal Review
• Proficient in Microsoft Office (Word, Excel, Outlook)
• Access to high-speed internet and reside within Central, Mountain, or Pacific Time Zone