Utilization Management Appeals Nurse Consultant

Role Overview

• Resolving clinical complaints and appeals by reviewing medical records
• Interpreting data obtained from clinical records to apply clinical criteria
• Coordinating clinical resolutions with internal and external support areas

Requirements

• Active, unrestricted RN license in your state of residence
• 3+ years Utilization Management or Utilization Review experience
• 1+ year(s) of experience demonstrating knowledge of clinical and medical policy
• 3+ years clinical nursing experience, with 1-3 years managed care experience
• 1+ year(s) of experience demonstrating knowledge of ICD-9, CPT, HCPC coding

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility