Clinical Review Specialist - RN - Appeals Writing

Clinical Review Specialist (RN) role involves evaluating hospitalizations across the country, utilizing medical knowledge and gaining experience as an expert advisor. The role involves performing retrospective clinical case reviews and drafting appeals to establish medical necessity of services performed.

Requirements

• RN License with strong clinical knowledge
• Minimum of 2-3 years of writing appeals letters and clinical auditing
• Minimum of 2-3 years Utilization Review / Case Management experience within the last 5 years
• Familiarity with payer guidelines and EMR systems like Epic, Cerner or Meditech
• Excellent attention to detail, written communication skills, and computer proficiency

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan