Responsible for managing medical appeals, the full-time Maryland Licensed Appeals RN will conduct reviews of clinical appeals, document findings, and collaborate with Medical Directors while working remotely. Key responsibilities Facilitates and manages medical appeals, ensuring compliance with regulatory and accreditation standards Conducts initial medical record reviews for clinical appeals and prepares summaries for Medical Director review Documents all appeals and reviews in the clinical software system, maintaining accurate and secure records Required qualifications Bachelor's degree in Nursing 5-7 years of diverse clinical experience, with knowledge of authorization processes 1-2 years of recent utilization review experience Active and unrestricted Nursing License in Maryland or the District of Columbia No prior or current Medicare or Medicaid sanctions
Maryland Licensed Appeals RN in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.