Remote Appeals Nurse: Medicare Medical Necessity Expert

WPS Health Solutions is seeking an Appeals Nurse (RN) to review first-level appeal cases for medical necessity and CMS compliance. You will collaborate with Appeals Examiners to ensure timely redeterminations and coordinate medical record reviews. The role requires an active RN license (state of practice) and 1+ year clinical experience, with strong communication and organization skills. The position supports remote work allowed in approved states, with salary in the 66-68k range and a focus on