Maryland Licensed Clinical Appeals Nurse

A company is looking for a Clinical Appeals Nurse (Remote). Key Responsibilities Investigates and analyzes written appeals and reconsideration requests from various sources, responding with detailed letters that comply with corporate policies and regulations Organizes appeal cases for physician review, compiling necessary information and communicating final decisions to members and providers Utilizes nursing expertise to assess appeal requests, collaborating with Independent Review Organizations and responding to regulatory complaints Required Qualifications High School Diploma or GED RN - Registered Nurse - State Licensure and/or Compact State Licensure upon hire required 2 years of medical-surgical or similar clinical experience OR 3 years in a mental health or psychiatric setting CCM - Certified Case Manager and LNCC - Legal Nurse Consultant Certified preferred upon hire Preferred: 2 years experience in Medical Review, Utilization Management, or Case Management in a healthcare payor organization

Created: 2026-03-05