Texas Licensed Clinical Appeals RN

Job Summary

A company is looking for a Clinical Appeals RN to review member appeals and work with medical directors for positive outcomes.

Key Responsibilities

• Analyze and review clinical appeals and grievances
• Act as a clinical liaison to resolve issues concerning members and providers
• Monitor and analyze medical management activities, providing analytical support to clinical programs

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+ years of Utilization Review or Medical Appeal Review experience
• Solid proficiency in Microsoft Office (Word, Excel, Adobe, Outlook)
• Access to high-speed internet and ability to work specified hours based on time zone