Progressive IT RN Supervisor-Clinical Appeals/ Pre-Certifications in Nashville, Tennessee

RN Supervisor-Clinical Appeals/ Pre-Certifications

Job Type:



Nashville, TN

Last Updated:


Job Description:

We are looking for a nurse, located in Nashville to be a supervisory lead over pre-certifications, clinical appeals and grievances. This person should have extensive Medicare Part C experience, supervisory experience and the experience to work with other consultants and the end client.

RN must have experience with managed care, utilization management, appeals or Medicare

Works to close clinical and pharmacy gaps and to mitigate non-clinical barriers to care

Registered Nurse Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions

Completes and files all assessments

Manages own caseloads and coordinates all assigned cases


Must have current licensure as a Registered Nurse (RN) in State of residency. Must be able to use computer system.

Excellent communication and interpersonal skills. Excellent time management, organization and negotiation skills. Ability to assess complex issues, recommend changes and resolve problems

Must have lead or supervisory Experience over pre-certifications, clinical appeals, and grievances.