Clinical Appeals Consultant Prn

Doctor Relocation LLC

West Valley City, Utah, US
Base: $40.39 - $60.96; bonus/equity: not specified...
Onsite
Evidence-based utilization criteria
Clinical assessments
Payer policies
Doctor Relocation LLC is seeking a Clinical Appeals Consultant to conduct clinical assessments and handle medical necessity appeals in West Valley City, Utah. The position requires a registered nurse with experience in utilization review and offers a competitive salary and benefits package

Job Summary

  • Uses nationally recognized, evidence-based utilization criteria to review medical records and perform clinical assessments for patient accounts to be appropriately appealed.
  • Collaborates with Care Management, Utilization Review, Physician Advisors, Revenue Integrity, Compliance, Legal Counsel and the RCO teams to prepare appeals.
  • We are committed to offering flexible work options where approved and stated in the job posting.

Matching Summary

Match Score: 85

Doctor Relocation LLC is seeking a Clinical Appeals Consultant to conduct clinical assessments and handle medical necessity appeals in West Valley City, Utah. The position requires a registered nurse with experience in utilization review and offers a competitive salary and benefits package.

Salary

Base: $40.39 - $60.96; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • evidence-based utilization criteria
  • clinical assessments
  • payer policies
  • Federal and State regulations
  • multidisciplinary teams

Nice-to-have

  • flexible work options
  • AI-enhanced recruitment process

Key Requirements

  • Graduate of an accredited school of nursing (Associates or Bachelor’s degree)
  • Current valid RN License
  • Three (3) years experience in utilization review or care management, hospital insurance billing, third party claim audits or auditing in a healthcare setting

Work Rights

Not specified

Tailored Resume

Cover Letter