New3d ago
- Specialty: Utilization Review
- Job type: Full-time
- Salary: $75,000 – $95,000
- License states: Compact
Weekend shiftAppeals+2
Job details- Utilization Review
- Full-time
- $70,000 – $100,000
- License: Compact
- 3+ years
Job description
The Appeals Nurse Consultant reviews medical necessity appeals for health plan members. This role involves analyzing clinical documentation, applying evidence-based criteria, and making coverage determinations. The position is fully remote and requires an active RN license with at least 3 years of clinical experience. Strong written communication and critical thinking skills are essential. Salary range: $70,000–$100,000.
Key responsibilities
- Review medical necessity appeals
- Analyze clinical documentation
- Apply evidence-based criteria
- Make coverage determinations
What you bring
- Active RN license
- 3+ years clinical experience
- Critical thinking
- Written communication
Tags
100% RemoteAppealsUtilization Review
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