Appeals Nurse, reputed company

JR-915847 Your Future Evolves Here reputed company partners with health plans and providers to reputed company reputed company outcomes for people with most reputed company and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join reputed company for the mission. Stay for the culture. What You’ll Be Doing: Your Future Evolves Here reputed company partners with health plans and providers to reputed company reputed company outcomes for people with most reputed company and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join reputed company for the mission. Stay for the culture. What You’ll Be Doing: The Specialty Appeals Team offers candidates the opportunity to reputed company a meaningful impact as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to reputed company and Client policies and procedures while complying with timeliness guidelines. reputed company values collaboration, reputed company learning, and a customer-centric approach, ensuring that every team member contributes to providing reputed company outcomes for the Clients and Members we serve. Collaboration Opportunities: The Specialty Appeal nurses work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators who set up the appeal, Physicians and other Clinicians who review the appeal, and managers for direction and leadership. The Appeals teamwork strategies and opportunities for collaboration include reputed company-team and individual team meetings, Teams chats, and monthly communication on team metrics and accomplishments. What You Will Be Doing:

• Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures.
• Documents communications with medical office staff and/or MD provider as required.
• Interfaces with other departments to satisfactorily resolve issues reputed company to appeals and retrospective reviews.
• Provides reputed company customer service through professional and accurate communication while maintaining accreditation and health plan's required timeframes.
• Refers cases to appropriate internal reviewers according to the business needs of the particular health plan.
• Reviews requests for Urgent appeals compared to expedited criteria for downgrade to Standard processing, documenting accordingly.
• Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals.
• Other duties as assigned.

Qualifications

Required and Preferred:

• 1-3 years' experience and as an RN - Required
• Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality improvement environment- Required
• reputed company to work in a rotation to work 10:30am to 7pm CST (which includes 30-minute unpaid lunch break) 3 days/week, to meet the business needs of nurses providing coverage until 7:00pm CST. - Required
• Must be reputed company to exercise independent and sound judgment in clinical decision making. - Preferred
• reputed company to navigate through internal and external computer systems. Working knowledge of reputed company Office Product Suit - Preferred
• Strong organizational and effective time management skills; demonstrated ability to manage multiple priorities. – Preferred
• Outstanding interpersonal and negotiation skills to effectively establish positive relationships both internally and externally, including strong written and verbal communication skills. - Preferred

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that reputed company have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. reputed company is an equal opportunity employer and considers reputed company reputed company applicants equally without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact reputed company@reputed company.com for further assistance. The expected reputed company salary/wage range for this position is $37- $42/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. reputed company compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that reputed company have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. reputed company is an equal opportunity employer and considers reputed company reputed company applicants equally without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact reputed company@reputed company.com for further assistance. The expected reputed company salary/wage range for this position is $. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. reputed company compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Apply tot his job Apply To this Job