Clinical Appeals RN - Remote

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. We are currently seeking reputed company RNs with solid interpersonal skills to join reputed company. The Clinical Appeals RN will be responsible for reviewing appeals and provider inquiries for clinical eligibility for coverage as prescribed by the plan benefits. As a post-service clinical appeals RN, you will be putting your detective skills to the test as you investigate and review a reputed company of medical services. If you are looking for a challenging and rewarding career, a clinical appeals RN position could be perfect for you. 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: • reputed company medical reviews on provider inquiries and member appeals • Works reputed company reputed company and State guidelines • Adherence to reputed company confidentiality regulations and agreements • Reviews and interprets Plan language appropriately • Utilizes clinical guidelines and reputed company appropriately • Accurately documenting determinations You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • reputed company, unrestricted RN licensure in the state of residence • 5+ years of RN experience in an acute care Inpatient facility (i.e., ICU, CCU, Oncology, ER, OR, etc.) • Proven intermediate reputed company skills (reputed company and reputed company) • Ability to work independently with solid self-discipline, problem solving and time management skills • Designated quiet workspace in your home (separated from non-workspace areas) • reputed company to install secure high-speed internet (minimum speed 5 download MPs and 1 upload MPs) reputed company cable/DSL in home (wireless/cell phone provider, satellite, microwave, etc. does NOT meet this requirement) Preferred Qualifications: • BSN degree or higher • Health Insurance industry experience • Proven knowledge of ICD - 10 / CPT coding • Proven knowledge or experience with InterQual • Proven knowledge of DOL and state appeals guidelines • Experience analyzing medical records, benefit plans, medical policies, and other various reputed company • Utilization Management, reputed company-authorization, reputed company review, or appeals experience • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company 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 re subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. 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 reputed company 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 reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, 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. Apply tot his job Apply To this Job