| Appeal Resolution Nurse Job Description |
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| The following is a full job description for Appeal Resolution Nurse. Here are the requirements and responsibilities for Appeal Resolution Nurse along with statistics. If after reading this page you determine that Appeal Resolution Nurse is not the position you are looking for, you may want to try one of these similar titles: Appeal Resolution Senior Manager, Appeal Resolution Specialist, Appeal Resolution Supervisor, Appeal Resolution Senior Specialist, Appeal Resolution Manager, Staff Nurse - RN II, Staff Nurse - RN III, Staff Nurse - RN - Occupational Health, Staff Nurse Senior- RN - Occupational Health |
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| Requirements and Responsibilities For Appeal Resolution Nurse |
| Conducts the medical review activities needed to resolve and process clinical appeals and claims. Reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases. Understands and interprets applicable medical terminology, clinical procedures, regulations and policies. Documents cases according to guidelines and standard procedures. Prepares the documentation required for further medical review, hearings, and different appeal processes. Typically requires a bachelor's degree in nursing or equivalent. Requires a Registered Nurse (RN) license. Typically reports to a manager. Work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Typically requires 4 -7 years of related experience. |
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| Also referred to as: Grievance and Appeals Resolution Nurse |
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| Similar Jobs: Appeal Resolution Senior Manager, Appeal Resolution Specialist, Appeal Resolution Supervisor, Appeal Resolution Senior Specialist, Appeal Resolution Manager, Staff Nurse - RN II, Staff Nurse - RN III, Staff Nurse - RN - Occupational Health, Staff Nurse Senior- RN - Occupational Health |
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| Level of Education: Appeal Resolution Nurse Salaries with No Diploma, Appeal Resolution Nurse Salaries with a High School Diploma or Technical Certificate, Appeal Resolution Nurse Salaries with an Associate's Degree, Appeal Resolution Nurse Salaries with a Bachelor's Degree, Appeal Resolution Nurse Salaries with a Master's Degree or MBA, Appeal Resolution Nurse Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
