Appeals RN - 240125 New

Appeals Nurse (No Prior Appeals Experience Required)

Are you a Registered Nurse with a strong clinical background looking for a new challenge? We are seeking an Appeals Nurse to support the full spectrum of State and Federal Independent Dispute Resolution (IDR) case determinations. No prior appeals experience is required—just a solid foundation in clinical nursing, attention to detail, and a willingness to learn!

Key Responsibilities:

• Conduct clinical reviews, including chart screening, regulatory guidance compilation, and insurer requirement research.
• Support the appeals process by preparing electronic worksheets and final determinations.
• Act as a resource for administrative and clinical staff by providing training, problem-solving assistance, and technical support.
• Assist with training and mentoring new RNs as the department grows.
• Assess and adjudicate claims while ensuring accuracy and compliance.
• Participate in collaborative training and team discussions.

Qualifications:

• Active RN license (required).
• Strong clinical background with a minimum of two years of experience in a clinical setting.
• Experience with electronic medical records.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
• Problem-solving mindset with a desire to learn and adapt.

Why Join Us?

• No prior appeals experience needed—we provide training!
• Opportunity to transition into a growing field while utilizing your clinical expertise.
• Work in a dynamic environment where your clinical skills make a direct impact.

If you're ready to apply your clinical knowledge in a new way, we encourage you to apply today!