Appeals Nurse Consultant

Job Description: • Processing the medical necessity of Medicare appeals for participating providers • Requesting clinical, researching, and extrapolating pertinent clinical information • Applying appropriate Medicare Guidelines • Navigating through multiple computer system applications in a fast-paced department • Working independently as well as in a team environment remotely • Reviewing and resolving clinical appeals • Interpreting data obtained from clinical records to apply appropriate clinical criteria and policies Requirements: • Must have active and unrestricted RN licensure in state of residence • 3+ years clinical experience • Appeals, Managed Care, or Utilization Review experience preferred • Pre Certification or Pre Authorization experience • 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 and many other benefits depending on eligibility Apply tot his job Apply To this Job