RN Utilization Appeals Nurse

Staff positions forUtilization Review - Clinical Appeal Nurses

1) Research medical records and compose (in conjunction with a physician reviewer when indicated) clinically-based, medical necessity appeals to overturn payor denials, as assigned;
2) Follow-up on all appeals for determinations and additional actions/resolution;
3) Coordinate commercial/managed care audit requests, as assigned;
4) Validate and compile audit findings; and
5) Exit/finalize all completed audits, as requested.

Requirements are an LPN or RN with experience as a beside nurse, and preferable case management experience with experience with payor appeals and utilization review.



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