3 years of clinical experience; or 2 years of clinical experience plus 1 year of utilization/medical review, quality assurance, or home health experience
Associate Degree in Nursing or graduate of an accredited School of Nursing
Active, unrestricted RN license in the state of hire or active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Healthcare insurance experience preferred
Day-to-day work will focus heavily on reviewing medical records and provider appeals/denials, confirming appropriate coding, and determining whether a denial should be upheld or overturned.
Please ensure candidates are genuinely interested in an appeals/clinical review role and understand this is not a traditional bedside RN position before submitting.
Please confirm the candidate meets the required RN licensure and experience requirements listed above before submission.
Manager is specifically looking for candidates who demonstrate dependability and accountability.
