Utah Licensed Clinical Appeals Consultant

Job Summary

A company is looking for a Clinical Appeals Consultant who will perform clinical assessments and reviews for patient accounts to facilitate appropriate appeals.

Key Responsibilities

• Utilizes evidence-based criteria to conduct clinical reviews for insurance audits and appeals
• Assesses clinical appeal requests based on payer policies and regulations
• Collaborates with multidisciplinary teams to prepare and improve appeal processes

Required Qualifications, Training, and Education

• Graduate of an accredited nursing school (Associates or Bachelor's degree)
• Current valid RN License
• Three years of experience in utilization review or related healthcare settings
• Preferred Bachelor's or Master's degree in nursing
• Preferred five years of experience in utilization review or related healthcare settings