Kansas Licensed Nurse Consultant

To support the health and well-being of Kansans, the full-time Kansas Licensed Nurse Consultant will manage the review and processing of predeterminations, claims, and appeals, utilizing independent decision-making in accordance with medical policy and standards, while working remotely, hybrid, or onsite. Key responsibilities Independently resolve predeterminations, claims, and appeals using medical policy and Interqual criteria Respond to inquiries regarding medical necessity, correct coding, and audits while providing clinical support to internal staff Identify potential quality of care issues and assist with quality assurance and utilization management data analysis Required qualifications Current unrestricted Kansas RN licensure is required Minimum of 3 years of clinical nursing experience is required Bachelor's degree or equivalent in nursing is preferred CPC certification or the ability to obtain it within three years of hire is required RN experience in Surgical, Medical, Obstetric, and/or Utilization Management is preferred