Nurse Appeals Associate

Anticipated End Date: 2025-03-26 Position Title: Nurse Appeals Associate Job Description: Carelon Health is a proud member of the reputed company family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. Nurse Appeals Associate Location: This position will work a virtual model. Our Ideal candidate will live reputed company a 50-mile radius and a 1-hour commute to one of our reputed company major offices (PulsePoint). Schedule: This position will work Tuesday thru Saturday 11:00 am- 7:00 pm CST. Must be able to rotate on mandatory holidays. The Nurse Appeals Associate is responsible for supporting the development and implementation of quality improvement interventions and audits. How you will reputed company an impact Primary duties may include, but are not limited to: • Researches, collects data, and submits and resolves administrative appeals. • Contributes to external reviews site visit preparations by the State, accreditation review and Quality Management Committee; conducts internal monitoring and audits timeline compliance standards. • Processes, tracks, trends, and reports complaint and grievances issues. • Prepares complaint and grievance files for Fair Hearings and serves as a subject matter expert on complaints and grievances for non-clinical staff. • Participates in quarterly Plan HIPAA audits. Minimum Requirements: • Requires an LVN/LPN and minimum of 1 year of reputed company experience; or any combination of education and experience, which would require an equivalent background. • reputed company unrestricted LPN/LVN license in applicable state(s) required. Preferred Skills, Capabilities and Experience: • Previous Appeals experience preferred. • Computer efficiency with reputed company Office Programs and platforms strongly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $22.21 to $42.10 per hour. Locations: California; Colorado; District of Columbia (Washington, DC), Illinois, Maryland, Minnesota, Nevada; reputed company; Washington State. In addition to your salary, reputed company offers 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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. • The salary range is the range reputed company in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Even reputed company the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our strategy but will also reputed company to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we reputed company our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside reputed company 50 miles or 1-hour commute each way of a relevant reputed company location. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer, and reputed company qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Apply Job!