State Licensed RN Appeal Writer
A company is looking for an Independent Contractor-Hospital RN specializing in Appeal Writing and Denials Management. Key Responsibilities Perform retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials Construct and document clinical cases to support appeals using appropriate medical necessity criteria Demonstrate critical thinking and decision-making skills in the clinical appeal process Required Qualifications RN or MD degree with an active unrestricted clinical license in at least one U.S. state Minimum of 5 years recent acute-care hospital experience preferred Minimum of 2 years of Utilization Review or Case Management experience within the last 5 years Managed care payor experience in Utilization Review, Case Management, or Appeals is a plus Must be computer proficient
A company is looking for an Independent Contractor-Hospital RN specializing in Appeal Writing and Denials Management.
Key Responsibilities
Perform retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials
Construct and document clinical cases to support appeals using appropriate medical necessity criteria
Demonstrate critical thinking and decision-making skills in the clinical appeal process
Required Qualifications
RN or MD degree with an active unrestricted clinical license in at least one U.S. state
Minimum of 5 years recent acute-care hospital experience preferred
Minimum of 2 years of Utilization Review or Case Management experience within the last 5 years
Managed care payor experience in Utilization Review, Case Management, or Appeals is a plus
Must be computer proficient
