Job Summary
A business services company is in need of a Telecommute Grievances and Appeals Registered Nurse.
Core Responsibilities of this position include:
- Acting as a member advocate addressing member or provider concerns
- Researching, investigating, and summarizing complex issues using state and federally mandated benefits
- Prepare cases for Medical Director and/or External Review
Applicants must meet the following qualifications:
- Quarterly travel for team events and trainings
- Active, unrestricted Registered Nurse license
- Minimum of 2 years of appeals experience in a payer-based environment
- Minimum of 5 years of acute care or outpatient clinical experience
- Minimum of 3 years of utilization management experience in a payer-based environment
- Excellent written and oral communication skills
