Working remotely, the Licensed RN Appeals Nurse will review medical records, create clinical analyses and appeal letters, and manage accounts to overturn clinical denials from Medicare, Medicaid, and other third-party payers. Key responsibilities Review medical record documentation to verify medical necessity issues related to claims Create detailed clinical analyses and appeal letters to support payment of patient claims Identify root causes and trends to share with clients and staff for ongoing training and improvement Required qualifications Licensed RN with at least 2 years of experience in an acute care hospital 3 to 5 years of experience in utilization review, case management, or related fields preferred Experience using InterQual and Milliman healthcare criteria preferred Familiarity with CMS LCD/NCD criteria preferred Proficient typing and computer skills essential
Licensed RN Appeals Nurse in workfromhome at Unknown Company
- Typical pay
- $71,760–$112,100
For context, most registered nurses earn between $71,760–$112,100 a year according to Bureau of Labor Statistics wage data. What this particular role pays is set by the employer — check the description above.
This position is listed as full time and able to be worked remotely.