Job Description:
• Responsible for the review and resolution of clinical appeals
• Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues
• Independently coordinates the clinical resolution with internal/external clinician support as required
• This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals
Requirements:
• Must have active and unrestricted RN licensure in state of residence
• 3+ years clinical experience
• Appeals, Managed Care, or Utilization Review experience preferred
• Proficiency with computer skills including navigating multiple systems
• Exceptional communication skills
• Time efficient, highly organized, and ability to multitask
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
Apply Now
Apply Now