RN Appeals Nurse Consultant
A company is looking for an Appeals Nurse Consultant.
Key Responsibilities
• Process medical necessity appeals for Medicare Part C from members and providers
• Collaborate with internal and external partners to gather and evaluate necessary information
• Provide written recommendations based on clinical data while adhering to guidelines
Required Qualifications
• Active and unrestricted RN licensure in state of residence
• 3+ years of clinical experience
• Associate's Degree in Nursing required; Bachelor's Degree preferred
• Experience in appeals, utilization review, or Medicare is preferred
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