Remote Clinical Appeals Nurse (RN)
Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025
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Job Description:
A company is looking for a Clinical Appeals Nurse (RN)
Remote.
Key Responsibilities
Perform clinical/medical reviews of retrospective medical claim
reviews and previously denied cases
Document clinical review summaries and provide supporting
documentation for denial and modification of payment decisions
Assist with complex claim reviews and identify quality of care
issues
Required Qualifications
Graduate from an Accredited School of Nursing; Bachelor's degree in
Nursing preferred
3-5 years clinical nursing experience, with 1-3 years in Managed
Care
Knowledge of ICD-9, CPT coding, HCPC, and CMS Guidelines
Active, unrestricted State Registered Nursing (RN) license in good
standing
Preferred: 5+ years Clinical Nursing experience, including hospital
acute care/medical experience
Keywords: VirtualVocations, Rancho Santa Margarita , Remote Clinical Appeals Nurse (RN), Healthcare , Vista, California
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