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Licensed Appeals Nurse
A company is looking for an Appeals Nurse to join their team. Key Responsibilities: Communicates with medical office personnel to gather clinical information and documents rationale for approvals and denials Interfaces with various departments to resolve issues related to appeals and retrospective reviews Tracks post-determination cases to completion and ensures compliance with health plan policies Required Qualifications: 1-3 years of experience in clinical Appeals Review or Utilization Management Review as an LPN or RN Ability to exercise independent judgment in clinical decision-making Strong organizational and time management skills Outstanding interpersonal and negotiation skills Computer literate and able to navigate internal and external systems
A company is looking for an Appeals Nurse to join their team.
Key Responsibilities:
Communicates with medical office personnel to gather clinical information and documents rationale for approvals and denials
Interfaces with various departments to resolve issues related to appeals and retrospective reviews
Tracks post-determination cases to completion and ensures compliance with health plan policies
Required Qualifications:
1-3 years of experience in clinical Appeals Review or Utilization Management Review as an LPN or RN
Ability to exercise independent judgment in clinical decision-making
Strong organizational and time management skills
Outstanding interpersonal and negotiation skills
Computer literate and able to navigate internal and external systems
