State Licensed Appeals Nurse Consultant
A company is looking for a Utilization Management Appeals Nurse Consultant (Remote).
Key Responsibilities
• Administers review and resolution of clinical complaints and appeals
• Interprets data from clinical records to apply appropriate clinical criteria and policies
• Coordinates clinical resolutions with internal and external support areas
Required Qualifications
• 3+ years of Utilization Management or Utilization Review experience
• 3+ years of clinical nursing experience, with 1-3 years in managed care
• 1+ year of experience with ICD-9, CPT coding, and HCPC
• 1+ year of experience with clinical and medical policy, including Milliman Care Guidelines or InterQual
• Active, unrestricted RN license in the state of residence
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