Licensed Appeals Nurse
Company: VirtualVocations
Location: Vista
Posted on: May 24, 2025
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Job Description:
A company is looking for an Appeals Nurse to join their
team.
Key Responsibilities:
Communicates with medical office personnel to gather clinical
information and documents rationale for approvals and denials
Interfaces with various departments to resolve issues related to
appeals and retrospective reviews
Tracks post-determination cases to completion and ensures
compliance with health plan policies
Required Qualifications:
1-3 years of experience in clinical Appeals Review or Utilization
Management Review as an LPN or RN
Ability to exercise independent judgment in clinical
decision-making
Strong organizational and time management skills
Outstanding interpersonal and negotiation skills
Computer literate and able to navigate internal and external
systems
Keywords: VirtualVocations, Santa Ana , Licensed Appeals Nurse, Healthcare , Vista, California
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