Appeals Nurse Consultant

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 • This is a full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM (local time) • Occasional weekend and holiday on-call coverage may be required 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 • Associate's Degree minimum 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 • Benefit solutions that address the different needs and preferences of our colleagues including 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