Job Summary
A company providing healthcare, life insurance, and accident insurance services is seeking a Remote Appeals Utilization Review Nurse I.
Candidates will be responsible for the following:
- Identifying and obtaining all additional information needed to make an appropriate determination
- Making an appropriate administrative determinations
- Completing necessary documentation
Position Requirements Include:
- Registered Nurse
- 3-5 years’ experience in Medicare Advantage Health Plans or related experience
- Working knowledge of Medicare Advantage, Original Medicare and or Medicaid appeal regulations
- Experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C
- Proficient in Microsoft Office products (Access, Excel, Power Point, Word)
