Clinical Appeals Manager
Company: VirtualVocations
Location: Whittier
Posted on: September 3, 2024
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Job Description:
A company is looking for a Manager, Clinical Appeals.
Key Responsibilities:
Assist in coordination and management of the clinical appeals
process related to adverse benefit determinations
Oversee clinical appeals data and processes to maintain industry
standards and practices
Analyze under and over utilization information for impact on member
quality of care and outcomes
Required Qualifications, Training, and Education:
Associate's Degree in Nursing required, Bachelors of Science in
Nursing (BSN) preferred
Minimum of five years of clinical experience
Minimum of five years of experience in utilization management,
appeals, and/or quality improvement
Two years of utilization management or appeals experience
preferred
Current, unrestricted licensure in state of practice as a
Registered Nurse (RN) required
Keywords: VirtualVocations, Whittier , Clinical Appeals Manager, Healthcare , Whittier, California
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