Clinical Appeals RN - NC Licensed

A company is looking for a Clinical Appeals RN to work remotely in the EST or CST time zone. Key Responsibilities Perform initial assessment review of appeals, medical records, and coverage criteria Identify additional information needed to process appeals Utilize clinical nursing judgment to make decisions on administrative nurse level cases Required Qualifications Current, valid, and unrestricted RN licensure in the state of residence 2+ years of clinical experience in an acute care or outpatient setting 1+ years of experience in Utilization Review or Medicaid/Medicare appeals Understanding of billable services and claims in a managed care environment Ability to work 8-5 within the EST time zone

Apr 3, 2025 - 23:42

A company is looking for a Clinical Appeals RN to work remotely in the EST or CST time zone. Key Responsibilities Perform initial assessment review of appeals, medical records, and coverage criteria Identify additional information needed to process appeals Utilize clinical nursing judgment to make decisions on administrative nurse level cases Required Qualifications Current, valid, and unrestricted RN licensure in the state of residence 2+ years of clinical experience in an acute care or outpatient setting 1+ years of experience in Utilization Review or Medicaid/Medicare appeals Understanding of billable services and claims in a managed care environment Ability to work 8-5 within the EST time zone