Responsible for managing Utilization Management medical appeal cases, the full-time remote New Jersey Licensed Appeals Analyst RN will ensure compliance with regulatory requirements, mentor appeals staff, and perform special projects as assigned. Key responsibilities Assess clinical needs against established guidelines to determine the appropriateness of inpatient care Investigate and resolve complicated appeals, coordinating with legal departments as necessary Prepare and present appeals to the Appeals Committee while ensuring compliance with regulatory standards Required qualifications High School Diploma/GED required; Bachelor's degree in healthcare management preferred 2 years of clinical experience required 3 years of experience in the healthcare delivery system/industry required Current Registered Nurse License required Working knowledge of principles of utilization management and healthcare contracts
New Jersey Licensed Appeals Analyst RN in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.