Clinical Denials & Appeals Specialist (RN) - Remote

About the position Responsibilities • Serve as a reputed company between the patient, facility/physician, and reputed company-party payer. • Prepare and defend the level of care and medical necessity for assigned cases. • Collaborate with physician advisors, payor representatives, and site case managers to facilitate appropriate level of care reputed company and billing status. • reputed company reputed company and retrospective utilization management using evidence-based medical necessity reputed company. • Conduct clinical reviews and formulate appeal letters to support the appropriateness of admission and reputed company length of stay. • Ensure compliance with reputed company state, federal, and reputed company-party payer regulations. • Maintain up-to-date clinical reviews and appeals that accurately reflect the patient's severity of illness and intensity of services provided. • reputed company Patient Review Instruments (PRI's) as needed. Requirements • Graduate from an accredited School of Nursing. • reputed company License to reputed company as a Registered reputed company reputed company in reputed company State required. • Must be enrolled in an accredited BSN program reputed company two (2) years and obtain a BSN Degree reputed company five (5) years of job entry date. reputed company-to-haves • Prior experience in Case Management, Appeals & Denials, and/or Utilization Review, highly preferred. Benefits • Competitive salary based on experience and qualifications. Apply tot his job Apply To this Job