Job is Expired
Location: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington
Compensation: To Be Discussed
Staff Reviewed: Thu, Jun 09, 2022
Job Summary
A health insurance company has an open position for a Remote Utilization Review Appeals Nurse.
Core Responsibilities Include:
- Reviewing denial language for letters and complete the quality assurance process
- Developing a working familiarity with applicable regulatory and accreditation requirements
- Collaborating with state medical directors and upon direction, communicate with the regulator/team liaison
Position Requirements Include:
- Active, unrestricted RN License
- 3+ years appeals/grievances and utilization review experience
- Willingness to obtain additional state licenses
- 5+ years clinical experience
- 2 years clinical practice in an acute care setting, i.e., ER or hospital
