Utilizing clinical expertise to resolve member and provider appeals, the full-time Registered Nurse Appeals Clinician will work remotely from Oregon, Washington, Idaho, or Utah, ensuring compliance with medical policies and conducting clinical appeal reviews. Key responsibilities Applies nursing expertise to ensure appeal decisions comply with medical necessity guidelines and industry standards Conducts clinical appeal reviews in accordance with member benefits and provider contracts Consults with physician advisers for clinically appropriate determinations and educates non-clinical staff on clinical cases Required qualifications Bachelor's Degree in Nursing with 3 years of clinical experience or equivalent combination of education and experience Active RN license in Oregon, Washington, Idaho, or Utah Experience in health insurance, coding/claims review, or case management Competency in claim review and familiarity with medical procedures and healthcare practices Knowledge of CPT, ICD-9, HCPCS coding, and Milliman Care Guidelines (MCG)
Registered Nurse Appeals Clinician in workfromhome at Unknown Company
- Typical pay
- $79,560–$137,280
For context, most registered nurses earn between $79,560–$137,280 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 contract and able to be worked remotely.