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