Job Summary
A health insurance company has a current position open for a Telecommute Medical Appeals and Grievances Clinical Specialist.
Core Responsibilities Include:
- Resolving of clinical cases, make critical decisions, and be respnsible for case development
- Preparing cases for medical director review ensuring that all pertinent diagnoses information
- Updating file documentation, and manage all duties within regulatory timeframes
Skills and Requirements Include:
- Must be an Reginstered Nurse or Licensed Practical Nurse
- Bachelor’s degree and experience in clinical practice with experience in appeals and grievances
- Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
- Ability to work independently on several computer applications such as Microsoft Word and Exce
- Demonstrated understanding of Utilization Review Guidelines, Millman or Medicare local coverage guidelines
