Grievance and Appeals Resolution Nurse Jobs

The Grievance and Appeals Resolution Nurse reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases. Conducts the medical review activities needed to resolve and process clinical appeals and claims. Being a Grievance and Appeals Resolution Nurse documents cases according to guidelines and standard procedures. Understands and interprets applicable medical terminology, clinical procedures, regulations and policies. In addition, Grievance and Appeals Resolution Nurse pre ... pares the documentation required for further medical review, hearings, and different appeal processes. Typically requires a bachelor's degree in nursing or equivalent. Requires a Registered Nurse (RN) license. Typically reports to a manager. Being a Grievance and Appeals Resolution Nurse work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Working as a Grievance and Appeals Resolution Nurse typically requires 4 -7 years of related experience. More
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