Clinical Denials & Appeals Specialist – Registered Nurse (Remote)

  • Anywhere

Employer Industry: Healthcare Services
Why Consider this Job Opportunity…
– Salary up to $70,000
– Opportunity for career advancement and growth within the organization
– Supportive and collaborative work environment
– Chance to make a positive impact on patient care and compliance
– Remote work schedule offering flexibility
What to Expect (Job Responsibilities):
– Serve as a liaison between patients, facilities, physicians, and third-party payers
– Prepare and defend level of care and medical necessity for assigned cases
– Collaborate with various stakeholders to facilitate appropriate level of care decisions and billing status
– Conduct concurrent and retrospective utilization management using evidenced-based criteria
– Ensure compliance with state, federal, and third-party payer regulations
What is Required (Qualifications):
– Graduate from an accredited School of Nursing
– Bachelor’s Degree in Nursing preferred
– Current License to practice as a Registered Professional Nurse in New York State
– Specialized certifications as needed
– Enrollment in an accredited BSN program within two years and obtain a BSN Degree within five years of job entry date
How to Stand Out (Preferred Qualifications):
– Prior experience in Case Management, Denials/Appeals, and/or Utilization Review
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