Appeals Nurse Consultant

This is a full-time telework position. Hours for this role are Monday-Friday 8a-5p in time zone of residence with the possibility of occasional on-call weekend requirements. Position Summary: Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. This position may support UM, MPO, Coding, or Behavioral Health appeals.