Appeals RN (no prior appeals experience required)

Appeals Nurse (No Prior Appeals Experience Required)

Are you a Registered Nurse with a strong clinical background looking for a new challenge? We are seeking an Appeals Nurse to support the full spectrum of State and Federal Independent Dispute Resolution (IDR) case determinations. No prior appeals experience is required-just a solid foundation in clinical nursing, attention to detail, and a willingness to learn!

• Conduct clinical reviews, including chart screening, regulatory guidance compilation, and insurer requirement research.
• Support the appeals process by preparing electronic worksheets and final determinations.
• Act as a resource for administrative and clinical staff by providing training, problem-solving assistance, and technical support.
• Assist with training and mentoring new RNs as the department grows.
• Assess and adjudicate claims while ensuring accuracy and compliance.
• Participate in collaborative training and team discussions.

• Active RN license (required).
• Strong clinical background with a minimum of two years of experience in a clinical setting.
• Experience with electronic medical records.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
• Problem-solving mindset with a desire to learn and adapt.

• No prior appeals experience needed-we provide training!
• Opportunity to transition into a growing field while utilizing your clinical expertise.
• Work in a dynamic environment where your clinical skills make a direct impact.

If you're ready to apply your clinical knowledge in a new way, we encourage you to apply today!

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.