Working remotely, the Licensed RN Appeals Nurse will review and appeal clinical denials from Medicare, Medicaid, and other payers, creating detailed analyses and managing accounts in a part-time capacity. Key responsibilities • Review medical record documentation to verify medical necessity issues related to claims • Create detailed clinical analyses and appeal letters to support payment of patient claims • Provide feedback to supervisors regarding issues identified for ongoing training to peers and non-clinical staff Required qualifications • Licensed RN with at least 2 years of experience in an acute care hospital • Three to five years of experience in utilization review, case management, or related fields preferred • Experience using InterQual and Milliman healthcare criteria preferred • Familiarity with CMS LCD/NCD criteria preferred • Proficient typing and computer skills essential
RSource, LLC d/b/a Knowtion Health is a healthcare services organization that provides clinical and administrative solutions and posts remote nursing and clinical roles.
