RN Clinical Appeals Nurse Remote

The RN Clinical Appeals Nurse provides support for internal appeals clinical processes, ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines.

Requirements

• At least 3 years clinical nursing experience
• Registered Nurse (RN) license
• Experience demonstrating knowledge of ICD-9, CPT coding, and HCPC
• Experience demonstrating knowledge of CMS guidelines, MCG, InterQual, or other medically appropriate clinical guidelines
• Critical-thinking skills
• Ability to interact effectively with clinical leaders and peers
• Strong verbal and written communication skills
• Microsoft Office suite proficiency

Benefits

• Competitive benefits and compensation package
• Equal Opportunity Employer (EOE) M/F/D/V