Job Title: Clinical Appeals RN
Start Date: Nov. 9th or asap!
Contract Duration: 3 months with possibility of extension! (The client could possibly go back onsite if there was an extension.)
**40 hours/week preferred - Some weeks where hours are less than 40 due to work volume fluctuation.
The Clinical Appeal Consultant will provide assessment and written analysis of individual case review and the consistent application of applicable criteria, rules, provider payment processes and member benefits, while assuring compliance with regulatory rules and accreditation standards related to clinical appeals and special inquiries. Additionally, this individual will serve as a resource and subject matter expert to all levels within the organization on accreditation and compliance as related to appeal activities.
- Associate’s Degree from an accredited nursing program.
- Active and unrestricted RN license in Iowa. Individual must be licensed in the state in which they reside.
- 4+ years of experience as a Registered Nurse or related role in a health care delivery or managed care setting:
- Excellent analytical, time management and problem solving skills. Strong attention to detail and ability to identify, research, and evaluate issues, organize information, and make appropriate decisions.