Registered Nurse Appeals Specialist

Job Summary

A company is looking for an Appeals Registered Nurse.

Key Responsibilities

• Adhere to company policies and procedures while managing appeals and utilization management
• Document communications with medical office staff and resolve issues related to appeals
• Collaborate with clinical reviewers to ensure timely adjudication of processed appeals

Required Qualifications

• 1-3 years of experience as a Registered Nurse
• Minimum of 5 years in Utilization Management or healthcare appeals
• Able to work 10:30am to 7pm CST for 3 days a week
• Must exercise independent judgment in clinical decision-making
• Proficient in navigating internal and external computer systems