State Licensed Appeals Nurse
Company: VirtualVocations
Location: Pasadena
Posted on: January 27, 2025
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Job Description:
A company is looking for an Appeals Review Nurse to join their
Clinical Review team.
Key Responsibilities
Complete medical necessity and level of care reviews using clinical
judgment and guidelines
Obtain necessary information to assess a member's clinical
condition and apply evidence-based guidelines
Ensure compliance with decision-making SLAs and refer members for
further care when needed
Required Qualifications
Active, unrestricted RN licensure from the United States or compact
multistate license
Associate Degree in Nursing or equivalent from an accredited
program
Ability to obtain additional state licenses as needed
1+ year of utilization review experience in a managed care
setting
1+ years of clinical experience in an acute care setting
Keywords: VirtualVocations, Los Angeles , State Licensed Appeals Nurse, Healthcare , Pasadena, California
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