Remote Appeals Nurse: Medicare Medical Necessity Expert

WPS Health Solutions

WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims information for first-level appeal cases, determining medical necessity under Medicare guidelines. You will collaborate with Appeals Examiners to ensure redeterminations are medically reviewed and completed timely.

The role requires an active RN license (ASN/BSN), 1+ year clinical experience, strong communication and meticulous organizational skills, and the ability to work remotely from approved states.

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Vacancy posted 13 hours ago

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