Responsible for managing Utilization Management medical appeal cases, the full-time New Jersey Licensed Appeals Resolution RN will ensure compliance with regulatory requirements, mentor appeals staff, and handle special projects while working remotely. Key responsibilities Assess patients' clinical needs against established guidelines to ensure appropriate care levels and lengths of stay Investigate and resolve complicated appeals, coordinating with legal departments and preparing cases for the Appeals Committee Document and communicate effectively with facilities, physicians, and members to ensure continuity of care 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 and 3 years in the health care delivery system/industry required Current Registered Nurse License in New Jersey Knowledge of utilization management principles and health care contracts Strong negotiation skills and ability to manage multiple priorities in a high-volume environment
New Jersey Licensed Appeals Resolution RN in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.