Clinical Denials and Appeals RN

Conduct pre- and post-service medical necessity reviews, perform retrospective medical record reviews, and identify denial root causes. Collaborate with teams to resolve denials and prevent recurrence.

Requirements

• Current unrestricted Registered Nurse license in the state you reside.
• University Degree and minimum 4-6 years of prior relevant experience in acute care clinical experience in hospital setting.
• Prior experience in clinical denials, utilization review, case management, or appeals required.
• Experience with InterQual and/or Milliman Care Guidelines, and electronic medical record systems.

Benefits

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program