Utah Licensed Clinical Appeals Consultant

A company is looking for a Clinical Appeals Consultant who will perform clinical assessments and reviews for patient accounts to facilitate appropriate appeals. Key Responsibilities Utilizes evidence-based criteria to conduct clinical reviews for insurance audits and appeals Assesses clinical appeal requests based on payer policies and regulations Collaborates with multidisciplinary teams to prepare and improve appeal processes Required Qualifications, Training, and Education Graduate of an accredited nursing school (Associates or Bachelor's degree) Current valid RN License Three years of experience in utilization review or related healthcare settings Preferred Bachelor's or Master's degree in nursing Preferred five years of experience in utilization review or related healthcare settings

Mar 24, 2025 - 21:48

A company is looking for a Clinical Appeals Consultant who will perform clinical assessments and reviews for patient accounts to facilitate appropriate appeals. Key Responsibilities Utilizes evidence-based criteria to conduct clinical reviews for insurance audits and appeals Assesses clinical appeal requests based on payer policies and regulations Collaborates with multidisciplinary teams to prepare and improve appeal processes Required Qualifications, Training, and Education Graduate of an accredited nursing school (Associates or Bachelor's degree) Current valid RN License Three years of experience in utilization review or related healthcare settings Preferred Bachelor's or Master's degree in nursing Preferred five years of experience in utilization review or related healthcare settings