Responsible for managing Utilization Management medical appeal cases, the full-time remote New Jersey Licensed Appeals Analyst RN will ensure compliance with regulatory guidelines, mentor appeals staff, and conduct reviews of medical records while providing 24/7 on-call support as scheduled. Key responsibilities Assess patients' 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 and conduct presentations on the appeals process to internal stakeholders Required qualifications High School Diploma/GED required; Bachelor's degree in health care management preferred or relevant experience in lieu of degree 2 years of clinical experience required 3 years of experience in the health care delivery system/industry required Current Registered Nurse License required Working knowledge of principles of utilization management and health care contracts
New Jersey Licensed Appeals Analyst RN in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.