State Licensed Clinical Appeals Nurse

VirtualVocations

To support the medical management team, the full-time State Licensed Clinical Appeals Nurse will investigate and process medical necessity requests from members and providers while working remotely. Key responsibilities Conducts investigations and reviews for member and provider medical necessity appeals Reviews medical records of denied services and provides summaries to the medical director and care team Ensures compliance with appeal timeframes and documentation standards Required qualifications Current Registered Nurse or Licensed Practical Nurse license issued by the state or multi-state license through the enhanced Nurse Licensure Compact (eNLC) Three years of clinical claims processing and review experience Three years of experience working with appeals and grievances Two years of customer service experience Bachelor of Science in Nursing is preferred

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Vacancy posted 5 days ago

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