Remote Clinical Appeals Nurse

Job is Expired

Location: Ohio

Compensation: To Be Discussed

Staff Reviewed: Tue, Oct 19, 2021

Job Category: Healthcare

Remote Level: 100% Remote

Employer Type: Employer

Career Level: Experienced

Job Summary

A healthcare company is in need of a Remote Clinical Appeals Nurse.

Individual must be able to fulfill the following responsibilities:

  • Conduct reviews of member appeals
  • Conduct retrospective, concurrent and prospective reviews for appropriateness of diagnostic procedures
  • Identify business priorities and necessary processes to triage and deliver work

Must meet the following requirements for consideration:

  • Current unencumbered RN license in Ohio
  • 2+ years of Appeals and Grievances experience with a health insurance company
  • Appeals experience for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side
  • 2+ years of acute clinical experience
  • In-depth knowledge of current standard of medical practices and insurance benefit structures
  • Detailed knowledge and competency in all types of medical-necessity decisions

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