Clinical Appeals
CareSource(1 month ago)
About this role
A Clinical Appeals Nurse is a licensed registered nurse responsible for adjudicating clinical appeals and representing the organization in state hearings to ensure regulatory compliance and alignment with medical policy. The role centers on applying clinical expertise and organizational policy to decisions across care settings and coordinating with clinical leadership. The position requires nursing licensure and experience in managed care or utilization review environments.
Required Skills
- Clinical Review
- Medical Records
- Policy Application
- Communication
- Decision Making
- Time Management
- Microsoft Office
- Facets
- Regulatory Knowledge
- Customer Service
Qualifications
- Associate's Degree
- Registered Nurse (RN) License
- Multi-state RN License (Preferred)
- MCG Certification (Required or within 6 months)
Apply instantly with AI
Let ApplyBlast auto-apply to jobs like this for you. Save hours on applications and land your dream job faster.
More jobs at CareSource
Similar Jobs
Clinical Appeals Nurse
Idaho(9 days ago)
Appeals Clinical Team Lead
PacificSource Health Plans(1 month ago)
Nurse Appeals Senior
Elevance Health(23 days ago)
Nurse Appeals RN-Quality of Care
Elevance Health(25 days ago)
Case Manager, Denials and Appeals, 40 Hours (Days)
BMC Company LLC(1 month ago)
Appeals Clinical Team Lead
PacificSource Health Plans(2 months ago)