Clinical Appeal Nurse

The Clinical Appeal Nurse is responsible for conducting daily clinical and benefit reviews in a quality-focused, production-driven environment. The role involves reviewing and analyzing pre and post service medical necessity and benefit appeals, post-service clinical claim disputes, and quality of care grievances.

Requirements

• Active and unrestricted RN or LPN license
• Minimum of 5 years' experience in Clinical Appeals and Grievances within a managed care or payor setting
• Minimum of 5 years' clinical experience across various care settings

Benefits

• Health insurance
• Paid time off
• Retirement plan
• 401(k) matching