Appeal Resolution Nurse Jobs

Conducts the medical review activities needed to resolve and process clinical appeals and claims. Reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases. Understands and interprets applicable medical terminology, clinical procedures, regulations and policies. Documents cases according to guidelines and standard procedures. Prepares the documentation required for further medical review, hearings, and different appeal processes. Typically requires a bachelor's degree ... in nursing or equivalent. Requires a Registered Nurse (RN) license. Typically reports to a manager. Work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Typically requires 4 -7 years of related experience. More
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