Clinical Appeals RN - Commercial Plan (M-F)- Remote

Required Qualifications: Active, unrestricted RN license in state of residence 5+ years of clinical experience as an RN including in an acute, inpatient hospital setting Experience applying benefits and criteria to clinical review Utilization Management, pre-authorization, concurrent review or appeals experience Solid computer skills including proficiency in Microsoft Office Word, Outlook, and Internet applications Ability to access multiple computer platforms Access to install secure high-speed internet (minimum speed 5 download mps & 1 upload mps) via cable/DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement) Designated quiet workspace in your home (separated from non-workspace areas) and able to be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI) Ability to work Monday - Friday Ability to work until 5pm in residing time zone Preferred Qualifications: Medical Coding experience/knowledge Experience using Interqual Experience with the following systems: UNET, iCUE/HSR, ATS, ETS or Cirrus Experience analyzing medical records, benefit plans, medical policies and other various criteria Demonstrated ability to work independently with solid self-discipline and time management skills Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills

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