Texas and New Mexico Licensed Clinical Appeals Nurse

A company is looking for a Clinical Appeals Nurse (RN) for remote work in Texas and New Mexico. Key Responsibilities Perform clinical reviews of denied cases and re-evaluate medical claims for appropriateness of services Resolve escalated complaints and identify quality of care issues while preparing cases for hearings Provide training and mentorship to less experienced nursing and administrative staff Required Qualifications Graduate from an Accredited School of Nursing; Bachelor's degree in Nursing preferred 3-5 years of clinical nursing experience, with 1-3 years in Managed Care Knowledge of ICD-9, CPT coding, CMS Guidelines, and applicable State regulatory requirements Active, unrestricted State Registered Nursing (RN) license in good standing Compact/multi-state licensure is required

Feb 10, 2025 - 18:30

A company is looking for a Clinical Appeals Nurse (RN) for remote work in Texas and New Mexico. Key Responsibilities Perform clinical reviews of denied cases and re-evaluate medical claims for appropriateness of services Resolve escalated complaints and identify quality of care issues while preparing cases for hearings Provide training and mentorship to less experienced nursing and administrative staff Required Qualifications Graduate from an Accredited School of Nursing; Bachelor's degree in Nursing preferred 3-5 years of clinical nursing experience, with 1-3 years in Managed Care Knowledge of ICD-9, CPT coding, CMS Guidelines, and applicable State regulatory requirements Active, unrestricted State Registered Nursing (RN) license in good standing Compact/multi-state licensure is required