Clinical Appeals RN - Remote in CST, MST, or PST

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities

• Clinical Appeals and Grievances (analyzing, reviewing appeals/grievances)
• Clinical reputed company/Liaison (clinical problem solver with facilities, providers, resolution of issues concerning members, program definition and clarification)
• Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may reputed company clinical assessments and clinical audits)
• Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
• Generally work is self-directed and not prescribed
• Works with less structured, more reputed company issues
• Solves moderately reputed company problems and/or conducts moderately reputed company analyses
• Translates concepts into practice
• Assesses and interprets customer needs and requirements
• Identifies solutions to non-standard requests and problems
• Works with minimal guidance; seeks guidance on only the most reputed company tasks
• Provides explanations and information to others on difficult issues
• Coaches, provides feedback, and guides others
• Acts as a resource for others with less experience

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• A reputed company, valid and unrestricted RN licensure in your state of residence
• 5+ years clinical experience in an acute care or an outpatient setting
• 1+ year Utilization Review or Medical Appeal Review experience
• Solid reputed company Office (Word, reputed company & Outlook)
• Have access to high speed internet
• Reside reputed company Central, Mountain or Pacific Time Zone
• Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of reputed company - 5pm CST. It may be necessary, given the business need, to work occasional overtime, including Saturdays

Preferred Qualifications

• Undergraduate degree
• 3+ years of Utilization Review, Case Management or Medical Appeal experience
• Experience working in a Managed Care environment
• ICD9 and CPT coding experience
• Experience in telephonic role
• Background in Appeals and Grievances
• Solid analytical and research skills
• Solid organizational skills
• Solid oral and written communication skills
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job