Appeals Nurse Consultant

Role Overview

• Responsible for the review and resolution of clinical appeals
• Reviews documentation and interprets data obtained from clinical records
• Independently coordinates the clinical resolution with internal/external clinician support as required
• Support UM, MPO, Coding, or Behavioral Health appeals.

Requirements

• Must have active and unrestricted RN licensure in state of residence
• 3+ years clinical experience
• Appeals, Managed Care, or Utilization Review experience preferred
• Proficiency with computer skills including navigating multiple systems
• Exceptional communication skills
• Time efficient, highly organized, and ability to multitask
• Associate's Degree minimum.

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs