California Licensed Clinical Appeals RN

Company: VirtualVocations
Location: Vista
Posted on: May 22, 2025

Job Description:

A company is looking for a Clinical Appeals RN to work remotely on post-service appeals for Medicare-based claims.
Key Responsibilities

Review provider post-service appeals for Medicare and Retirement
Gather clinical information, including medical records and coverage criteria, per Medicare guidelines
Discuss cases with medical directors and collaborate with other teams to process cases

Required Qualifications

Undergraduate degree or equivalent experience
Unrestricted, active RN license
2+ years of RN experience in an acute setting
Proven working knowledge of Clinical Criteria and CMS Guidelines
Demonstrated ability to have a HIPAA compliant home workspace

Keywords: VirtualVocations, Corona , California Licensed Clinical Appeals RN, Healthcare , Vista, California

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