Florida Licensed Clinical Appeals Nurse

Job Summary

A company is looking for a Clinical Appeals Nurse (RN).

Key Responsibilities

• Conducts clinical reviews of denied cases and assesses appropriateness of services provided
• Resolves escalated complaints and identifies quality of care issues
• Prepares and presents cases for hearings and serves 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 clinical nursing experience, with 1-3 years in Managed Care
• Knowledge of ICD-9, CPT coding, and CMS Guidelines
• Active, unrestricted State Registered Nursing (RN) license in good standing
• Preferred: 5+ years Clinical Nursing experience and relevant healthcare certifications