State Licensed Appeals Nurse - Oklahoma City Oklahoma

Company: VirtualVocations
Location: Oklahoma City, Oklahoma
Posted On: 02/06/2025

A company is looking for an Appeals Review Nurse to join their Clinical Review team.



Key Responsibilities

Complete medical necessity and level of care reviews using clinical judgment and guidelines
Obtain necessary information to assess a member's clinical condition and apply evidence-based guidelines
Ensure compliance with decision-making SLAs and refer members for further care when needed


Required Qualifications

Active, unrestricted RN licensure from the United States or compact multistate license
Associate Degree in Nursing or equivalent from an accredited program
Ability to obtain additional state licenses as needed
1+ year of utilization review experience in a managed care setting
1+ years of clinical experience in an acute care setting More...

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