Job Description

Employment Type:
Full Time 80
Shift:
Day
Other Shift Details:
Job Code:
R21

Job Summary

The RN Clinical Denials Specialist utilizes a clinical nursing background to address various types of inpatient payer denials, specifically those related to medical necessity and concurrent reviews. This will include working diligently with utilization review, coders, physician advisors, other team leads and payor representatives, in order to appeal claims and resolve issues causing these denials.

Minimum Education

Bachelor’s degree from accredited school of nursing

Required Skills

Minimum of 5 years’ experience, preferably in Utilization Review or Case Management, including denials processing and appeals; working knowledge of Medicare, Medicaid and third-party rules and regulations; working knowledge of Interqual and Milliman.

Required License

Current licensure in good standing in the state of Mississippi as a Registered Nurse

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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