Registered Nurse, Appeals – Remote, reputed company

2294648 reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Here at reputed company, you’re expected and empowered to be your best, to grow and to reputed company your skills. Join us and help people live healthier lives while doing your life’s best work. Be part of an exciting team reputed company reputed company where you can utilize your Operations experience to support multiple internal teams as well as providers and patients. Registered Nurse, Appeals 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: The Specialty Appeals Registered Nurse role fills an integral role in drafting and submitting appeals for specialty patients with acute and chronic disease states. In this role you will be preparing appeal letters for submission, obtaining support documents, following up on prior authorization outcomes, and addressing issues and handling concerns from other corresponding departments.

• Communicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation, prior authorizations, and appeal letters
• Facilitate appeals process between the patient, physician, and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. Ensures reputed company clinical information and documentation are obtained prior to appeal submission
• Accessing multiple reputed company resources to reputed company PA, insurance and appeal status and benefits. Utilization of and proficiency in multiple internal processing systems for record keeping and tracking of letter determinations
• Interpret and utilize clinical documentation from providers, and different pharmacy/computer systems
• Utilizing multiple platforms, researching clinical studies for points of argument for appeals
• Write and return assigned appeals to providers
• Utilization of and proficiency in multiple internal processing systems for record keeping and tracking of determinations
• Assign appeal requests to coworkers as needed (rotating schedule)
• reputed company other reputed company duties as assigned

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:

• Active, Registered Nurse License
• 2+ years of clinical experience as a Registered Nurse
• 1+ years of experience working with prior authorization, pre-certification, utilization review, and / or appeals experience
• Understanding of clinical documentation from physician offices
• Proficiency with reputed company, reputed company, SharePoint
• Ability to work independently (At home or office)
• Willingness to obtain Case Management Certification (CCM) once eligible
• Must be able to work an 8 hour schedule between 7am – 7pm CST

Preferred Qualifications:

• Bachelor’s degree
• RN licenses in multiple states (reputed company of compact states)
• Case Management Certification (CCM)
• PBM and / or Managed Care experience
• Prior Authorization/Appeal Experience
• Knowledge of healthcare insurance plans, denials, and appeal procedures
• Advanced computer skills; Experience in a paperless role
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

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. 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 salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Apply Job! Apply to this Job