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Wisconsin Licensed Clinical Appeals Nurse
A company is looking for a Clinical Appeals Nurse (RN). Key Responsibilities Perform clinical/medical reviews of denied cases and re-evaluate medical claims Apply clinical knowledge and regulatory guidelines to assess service appropriateness and resolve escalated complaints Prepare and present cases for administrative hearings and serve as a clinical resource for various stakeholders 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, and HCPC Active, unrestricted State Registered Nursing (RN) license in good standing Experience with CMS Guidelines and applicable State regulatory requirements
A company is looking for a Clinical Appeals Nurse (RN).
Key Responsibilities
Perform clinical/medical reviews of denied cases and re-evaluate medical claims
Apply clinical knowledge and regulatory guidelines to assess service appropriateness and resolve escalated complaints
Prepare and present cases for administrative hearings and serve as a clinical resource for various stakeholders
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, and HCPC
Active, unrestricted State Registered Nursing (RN) license in good standing
Experience with CMS Guidelines and applicable State regulatory requirements