Clinical Denial RN

Listing excerpt

Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: Conduct pre‑ and post‑service medical necessity reviews for inpatient, observation, and outpatient hospital encounters using evidence‑based criteria such as InterQual and Milliman Care Guidelines. Perform retrospective medical record reviews to validate completeness and accuracy of physician and clinical documentation supporting level of care and services rendered. Identify denial root causes…

Read the full text on Himalayas. Listing valid until 23 November 2026.