Clinical Review & Appeals Nurse - 249736 in Tempe, AZ

Clinical Review & Appeals Specialist (RN/LVN) Medix Healthcare Tempe, AZ 85288 Monday-Friday, FULL TIME $71,000 - 106,000 (Pay differs for an LPN) Qualifications/Requirements • Active and unrestricted Arizona Registered Nurse (RN) or Licensed Practical Nurse (LPN) license • 3+ years of clinical experience as an RN or LPN • Demonstrated expertise in MS Office suite software • Ability to independently prioritize and process a high volume of work Essential Duties and Responsibilities: As a Clinical Review & Appeals Specialist Nurse you will… • Evaluate and manage appeals related to insurance denials for air ambulance transports, with a focus on medical necessity determinations. • Work closely with clinical field teams to address documentation gaps and ensure all required materials are gathered to support appeal submissions. • Analyze medical records and clinical documentation to assess the appropriateness and necessity of care provided. • Coordinate with hospitals and external facilities to obtain complete and accurate medical records needed for appeal reviews. • Collaborate with patient advocacy groups to support patients in understanding their appeal options and navigating adverse benefit decisions. • Maintain adherence to all applicable federal, state, and payer-specific rules and requirements throughout the appeals process. • Track and analyze denial and appeal patterns, identify improvement opportunities, and contribute to quality and process enhancement initiatives. • Collect, organize, and submit supporting documentation for a variety of clinical and operational requests, including materials from air ambulance clinical teams. • Complete additional responsibilities as assigned. Work Environment: This position is going to be ON SITE. Monday-Friday FULL TIME $71,000 - 106,000