Clinical Appeals Nurse - PST Hours Required
CareSource(1 month ago)
About this role
A Clinical Appeals Nurse at CareSource works within a managed care setting to ensure clinical appeal decisions and state hearing activities align with regulatory standards and organizational policies. The role requires clinical expertise and collaboration with clinical leadership and external agencies to maintain compliance across covered services.
Required Skills
- Clinical Review
- Medical Records
- Clinical Judgment
- Policy Application
- State Hearings
- Documentation
- Communication
- Time Management
- Microsoft Office
- Facets
Qualifications
- Associate Degree
- Registered Nurse (RN) License
- MCG Certification
- Multi-State RN License (Preferred)
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