Clinical Appeals RN - Oklahoma Licensed
A company is looking for a Clinical Appeals RN to provide expertise in clinical appeals and grievances while working remotely. Key Responsibilities: Review medical records and verify service criteria Evaluate post-service claims for clinical eligibility based on Plan benefits Document determinations accurately and adhere to confidentiality regulations Required Qualifications: Active, unrestricted RN license in state of residence 3+ years of clinical experience as an RN in an acute, inpatient hospital setting Experience in Utilization Management, pre-authorization, claim review, or medical record review Solid computer skills, including proficiency in Microsoft Office Designated HIPAA compliant home workspace with secure high-speed internet access
A company is looking for a Clinical Appeals RN to provide expertise in clinical appeals and grievances while working remotely.
Key Responsibilities:
Review medical records and verify service criteria
Evaluate post-service claims for clinical eligibility based on Plan benefits
Document determinations accurately and adhere to confidentiality regulations
Required Qualifications:
Active, unrestricted RN license in state of residence
3+ years of clinical experience as an RN in an acute, inpatient hospital setting
Experience in Utilization Management, pre-authorization, claim review, or medical record review
Solid computer skills, including proficiency in Microsoft Office
Designated HIPAA compliant home workspace with secure high-speed internet access
