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Clinical Appeals Nurse
2 months ago
Job Title: Clinical Appeals Nurse
Salary - (60k - 68k depending on experience)
Job Description
The Clinical Appeals Nurse is responsible for managing clinical appeals and state hearings across all states. This role involves reviewing and completing both provider and member clinical appeals within designated timeframes, preparing State Hearing packets, and ensuring communication with state agencies and internal departments. The successful candidate will attend State Hearings, issue notification letters, refer medical necessity denials, and maintain accurate documentation. Additionally, this role requires collaboration with the Quality Improvement and Clinical Operations Team to manage requests for Independent External Review and ensure compliance with regulatory standards.
Work Environment
Fully remote role. Consultants will need to provide their own equipment including phone, internet, computer, and monitors.
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