Massachusetts Licensed RN Appeal Administrator

A company is looking for an RN Denial/Appeal Administrator. Key Responsibilities Manage the medical and psychiatric pre-denial, denial, and appeal processes Utilize medical necessity screening tools to conduct initial and continued stay reviews Secure authorization for clinical services through collaboration with payers Required Qualifications Nursing degree: Diploma, ASN, or BSN (preferred), with the ability to obtain a BSN within 4 years MA RN License required CCM or ACM certification preferred 3-5 years of related experience in healthcare case management and patient insurance/billing 3-4 years of supervisory experience preferred

Mar 31, 2025 - 14:17

A company is looking for an RN Denial/Appeal Administrator. Key Responsibilities Manage the medical and psychiatric pre-denial, denial, and appeal processes Utilize medical necessity screening tools to conduct initial and continued stay reviews Secure authorization for clinical services through collaboration with payers Required Qualifications Nursing degree: Diploma, ASN, or BSN (preferred), with the ability to obtain a BSN within 4 years MA RN License required CCM or ACM certification preferred 3-5 years of related experience in healthcare case management and patient insurance/billing 3-4 years of supervisory experience preferred