Remote Appeals Nurse in Smithfield

Job ID: Available for Members

Location: Rhode Island

Compensation: To Be Discussed

Staff Reviewed: Tue, Feb 04, 2020

This job expires in 18 days

Job Category: Case Management, Healthcare, Nursing

Telecommute Level: Occasionally

Travel Requirements: Onsite Required, Some Travel

Weekly Hours: Full Time

Employment Status: Permanent

Employer Type: Employer

Career Level: Experienced

Education Level: Some College

Job Summary

A healthcare company is filling a position for a Remote Appeals Nurse in Smithfield.

Core Responsibilities Include:

  • Reviewing and evaluating all clinical appeals submitted to the company
  • Interpreting and explaining the company’s benefits, policies and procedures to members and providers
  • Monitoring assigned cases to ensure that resolution meets state and federally mandated timelines

Skills and Requirements Include:

  • Ability to telecommute up to 2 days per week
  • Registered Nurse (RN) with an active, current, unrestricted license in Rhode Island in good standing
  • Minimum one (1) year relevant clinical experience with general nursing exposure to Utilization Management
  • Minimum one (1) year of experience in a Grievances and Appeals OR Case Management-related setting