Reviewing payer denials and authoring appeal letters, the full-time Florida Licensed Utilization Review Nurse will focus on Medical Necessity denials while working remotely and collaborating with a Physician Advisor to ensure accurate and timely appeals. Key responsibilities Evaluate medical necessity denials against payer policies and clinical guidelines to determine appeal eligibility Author clear and persuasive medical necessity appeal letters based on clinical documentation and payer criteria Track denial reasons and outcomes to identify patterns and recommend process improvements Required qualifications Registered Nurse (RN) with at least 3 years of acute care hospital experience Minimum of 3 years of utilization review/utilization management experience Prior experience authoring medical necessity appeal letters Strong understanding of medical necessity criteria and payer policy Experience with InterQual and/or MCG criteria is preferred
Florida Licensed Utilization Review Nurse in workfromhome at Unknown Company
This position is listed as part time and able to be worked remotely.