Utah Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse (RN).

Key Responsibilities

• Perform clinical/medical reviews of previously denied cases and assess appropriateness of services
• Resolve escalated complaints regarding Utilization Management and identify quality of care issues
• Provide training and mentorship for less experienced nursing and administrative staff

Required Qualifications

• Graduate from an Accredited School of Nursing; Bachelor's degree in Nursing preferred
• 3-5 years of clinical nursing experience, with 1-3 years in Managed Care
• Knowledge of ICD-9, CPT coding, and HCPC
• Active, unrestricted State Registered Nursing (RN) license in good standing
• Experience with CMS Guidelines, MCG, InterQual, and applicable State regulatory requirements